MEDICARE: DR. MOLLY ELIZABETH BURNETT PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP451613	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	P00400633	OTHER	MEDICARE PIN
4	0282938441	OTHER	MEDICARE NSC
5	PHC049	OTHER	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3998967	OTHER	PA	NCPDP

General Provider Information

NPI Number	:	1447774724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY ELIZABETH BURNETT PHARMD

Provider Business Mailing Address
First Line	:	522 DELAWARE AVE
Second Line	:
City	:	NORWOOD
State	:	PA
Zip	:	19074-1106
Country	:	US
Telephone Number	:	610-316-9675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 S BROAD ST LBBY 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3426
Country	:	US
Telephone Number	:	267-330-0290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/28/2017

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Directions to “ DR. MOLLY ELIZABETH BURNETT PHARMD” Practice Location

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