Provider Demographics
NPI:1922064039
Name:BURDETT, ROBERT MILTON JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MILTON
Last Name:BURDETT
Suffix:JR
Gender:M
Credentials:RPH
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Mailing Address - Street 1:2360 E PERSHING BLVD
Mailing Address - Street 2:PHARMACY (119)
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5356
Mailing Address - Country:US
Mailing Address - Phone:307-778-7550
Mailing Address - Fax:307-778-7588
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:PHARMACY (119)
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:307-778-7588
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY2435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist