Provider Demographics
NPI:1760663850
Name:BURT, CHRISTY MACHELLE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:MACHELLE
Last Name:BURT
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 FORD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4480
Mailing Address - Country:US
Mailing Address - Phone:315-394-9592
Mailing Address - Fax:
Practice Address - Street 1:3000 FORD STREET EXT
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4480
Practice Address - Country:US
Practice Address - Phone:315-394-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist