Provider Demographics
NPI:1659000420
Name:BURES, GEORGE JOSEPH III (CPHT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:BURES
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:BURES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-6140
Mailing Address - Country:US
Mailing Address - Phone:816-625-3578
Mailing Address - Fax:
Practice Address - Street 1:400 S BROADWAY
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-6140
Practice Address - Country:US
Practice Address - Phone:816-625-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-19530183700000X
MO2022010497183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician