Provider Demographics
NPI:1750663373
Name:BURRIS, AUSTIN ALBERT (PHRAMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:ALBERT
Last Name:BURRIS
Suffix:
Gender:M
Credentials:PHRAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HAMLET ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1537
Mailing Address - Country:US
Mailing Address - Phone:740-502-0053
Mailing Address - Fax:
Practice Address - Street 1:1280 DEMOREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-7003
Practice Address - Country:US
Practice Address - Phone:614-279-1962
Practice Address - Fax:614-279-2827
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist