Provider Demographics
NPI:1962007807
Name:BURRESS, DAVECKIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVECKIO
Middle Name:
Last Name:BURRESS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BESSEMER SUPER HWY
Mailing Address - Street 2:
Mailing Address - City:MIDFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35228-2117
Mailing Address - Country:US
Mailing Address - Phone:205-925-0278
Mailing Address - Fax:
Practice Address - Street 1:604 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-2117
Practice Address - Country:US
Practice Address - Phone:205-925-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist