Provider Demographics
NPI:1760885834
Name:BURCH, STEPHEN DONALD
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DONALD
Last Name:BURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 CAISTOR LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7216
Mailing Address - Country:US
Mailing Address - Phone:479-461-3882
Mailing Address - Fax:919-803-1765
Practice Address - Street 1:1317 CAISTOR LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7216
Practice Address - Country:US
Practice Address - Phone:479-461-3882
Practice Address - Fax:919-803-1765
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist