Provider Demographics
NPI:1396940516
Name:BURNS, ELIZABETH M (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27278 STATE HWY 18
Mailing Address - Street 2:PO BOX 426
Mailing Address - City:GARRISON
Mailing Address - State:MN
Mailing Address - Zip Code:56450
Mailing Address - Country:US
Mailing Address - Phone:320-525-3401
Mailing Address - Fax:
Practice Address - Street 1:27278 STATE HWY 18
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:MN
Practice Address - Zip Code:56450
Practice Address - Country:US
Practice Address - Phone:320-525-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN705706183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician