Provider Demographics
NPI:1598291908
Name:BURD, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BURD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19333 COLLINS AVE
Mailing Address - Street 2:409
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2336
Mailing Address - Country:US
Mailing Address - Phone:201-960-6470
Mailing Address - Fax:
Practice Address - Street 1:1776 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1129
Practice Address - Country:US
Practice Address - Phone:305-358-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist