Provider Demographics
NPI:1629477120
Name:BURCHETT, MAX EUGENE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:EUGENE
Last Name:BURCHETT
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:EUGENE
Other - Last Name:BURCHETT-ZUNIGA
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4913 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6339
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:405-948-4929
Practice Address - Street 1:4913 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6339
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4929
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK154441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK15444OtherOK PHARMACY LICENSE