Provider Demographics
NPI:1609116797
Name:BURCH, STEVEN JACK (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JACK
Last Name:BURCH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 KITTY HAWK RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3806
Mailing Address - Country:US
Mailing Address - Phone:210-945-2120
Mailing Address - Fax:210-945-2134
Practice Address - Street 1:910 KITTY HAWK RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3806
Practice Address - Country:US
Practice Address - Phone:210-945-2120
Practice Address - Fax:210-945-2134
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist