Provider Demographics
NPI:1932634441
Name:BURNHAM, ELIZAVETA SERGEYEVNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZAVETA
Middle Name:SERGEYEVNA
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5791
Mailing Address - Country:US
Mailing Address - Phone:831-636-1692
Mailing Address - Fax:831-636-3889
Practice Address - Street 1:1701 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5791
Practice Address - Country:US
Practice Address - Phone:831-636-1692
Practice Address - Fax:831-636-3889
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist