Provider Demographics
NPI:1972053742
Name:BURGESS, CYNTHIA PETERS (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:PETERS
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 JW CLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5415
Mailing Address - Country:US
Mailing Address - Phone:704-593-0769
Mailing Address - Fax:704-593-0710
Practice Address - Street 1:8909 JW CLAY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-5415
Practice Address - Country:US
Practice Address - Phone:704-593-0769
Practice Address - Fax:704-593-0710
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08574183500000X
SC6211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist