Provider Demographics
NPI:1710225933
Name:BURGHARDT, AMY BARTLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BARTLEY
Last Name:BURGHARDT
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 1:1260 MCALLISTAR DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2480
Mailing Address - Country:US
Mailing Address - Phone:770-898-6740
Mailing Address - Fax:
Practice Address - Street 1:2730 HIGHWAY 155
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2401
Practice Address - Country:US
Practice Address - Phone:770-288-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA021699OtherGA STATE BOARD OF PHARMACY