Provider Demographics
NPI:1659826014
Name:BURGESS, JEFFREY PHILLIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:BURGESS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 COLLIER PKWY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5286
Mailing Address - Country:US
Mailing Address - Phone:813-948-9910
Mailing Address - Fax:
Practice Address - Street 1:2121 COLLIER PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5286
Practice Address - Country:US
Practice Address - Phone:813-948-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist