Provider Demographics
NPI:1023095759
Name:BURROUGHS, MARK E (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:USCG HQ, COMDT (CG-1122)
Mailing Address - Street 2:2100 2ND STREET, RM 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-267-0694
Mailing Address - Fax:202-267-4685
Practice Address - Street 1:USCG HQ, COMDT (CG-1122)
Practice Address - Street 2:2100 2ND STREET, RM 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-267-0694
Practice Address - Fax:202-267-4685
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist