Provider Demographics
NPI:1649517707
Name:BURGESS, JILLIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 BOLL WEEVIL CIR
Mailing Address - Street 2:STE 112
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2472
Mailing Address - Country:US
Mailing Address - Phone:334-348-1526
Mailing Address - Fax:334-348-1978
Practice Address - Street 1:847 BOLL WEEVIL CIR
Practice Address - Street 2:STE 112
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2472
Practice Address - Country:US
Practice Address - Phone:334-348-1526
Practice Address - Fax:334-348-1978
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist