Provider Demographics
NPI:1245954338
Name:BURNS, THOMAS ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT
Last Name:BURNS
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 1:1550 GEZON PKWY SW STE E-100
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9397
Mailing Address - Country:US
Mailing Address - Phone:616-878-8226
Mailing Address - Fax:
Practice Address - Street 1:2275 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9625
Practice Address - Country:US
Practice Address - Phone:616-574-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty