Provider Demographics
NPI:1790805794
Name:BURTON, FRANKLIN GAIL II (RPH)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:GAIL
Last Name:BURTON
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10052 N COCKRUM DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-7119
Mailing Address - Country:US
Mailing Address - Phone:662-233-4567
Mailing Address - Fax:
Practice Address - Street 1:7253 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1906
Practice Address - Country:US
Practice Address - Phone:662-895-8383
Practice Address - Fax:662-895-9088
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9537183500000X
TN8920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9537OtherLICENSE
TN8920OtherLICENSE