Provider Demographics
NPI:1740350230
Name:BURGESS, JULIE W (RPH)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:W
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23927 INDIAN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467
Mailing Address - Country:US
Mailing Address - Phone:334-493-4698
Mailing Address - Fax:
Practice Address - Street 1:301A EAST THREE NOTCH STREET
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-8825
Practice Address - Fax:334-222-2761
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist