Provider Demographics
NPI:1184900474
Name:BURGER, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10826 E MAPLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5742
Mailing Address - Country:US
Mailing Address - Phone:303-771-3431
Mailing Address - Fax:
Practice Address - Street 1:7190 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3014
Practice Address - Country:US
Practice Address - Phone:303-773-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11194OtherCOLORADO STATE BOARD OF PHARMACY