Provider Demographics
NPI:1831144500
Name:BURRUSS, ROYCE ALLEN (RPH MBA)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:ALLEN
Last Name:BURRUSS
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12146 POPLAR CREST CT
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7264
Mailing Address - Country:US
Mailing Address - Phone:804-955-0615
Mailing Address - Fax:
Practice Address - Street 1:7172 COLUMBIA GATEWAY DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2993
Practice Address - Country:US
Practice Address - Phone:888-662-6779
Practice Address - Fax:888-548-2589
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004449183500000X
NC16630183500000X
MD15047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist