Provider Demographics
NPI:1669077384
Name:BURTON, CHAD PATRIC
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:PATRIC
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 W OREM DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1250
Mailing Address - Country:US
Mailing Address - Phone:713-723-1118
Mailing Address - Fax:713-723-5992
Practice Address - Street 1:4402 WILLOW CREST LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-2032
Practice Address - Country:US
Practice Address - Phone:832-722-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist