Provider Demographics
NPI:1841548963
Name:BURT, REBECCA LEE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:BURT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7128 E RENO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4478
Mailing Address - Country:US
Mailing Address - Phone:405-737-3464
Mailing Address - Fax:405-737-9554
Practice Address - Street 1:7128 E RENO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4478
Practice Address - Country:US
Practice Address - Phone:405-737-3464
Practice Address - Fax:405-737-9554
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist