Provider Demographics
NPI:1598826497
Name:BURKHALTER, NANCY A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:BURKHALTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL RD
Mailing Address - Street 2:FAMILY MEDICINE CLINIC
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-0025
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL RD
Practice Address - Street 2:2ND FLOOR, FAMILY MEDICINE CLINIC
Practice Address - City:FORT. GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-0025
Practice Address - Fax:706-787-9356
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0086131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy