MEDICARE: STACIA BURTON PHARMD, RPH

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	014011	KY

General Provider Information

NPI Number	:	1649800921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIA BURTON PHARMD, RPH

Provider Business Mailing Address
First Line	:	4750 HARTLAND PKWY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-1558
Country	:	US
Telephone Number	:	859-245-5855
Fax Number	:	859-272-5539

Provider Business Practice Location Address
First Line	:	4750 HARTLAND PKWY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-1558
Country	:	US
Telephone Number	:	859-245-5855
Fax Number	:	859-272-5539

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

Provider Enumeration Date	:	01/25/2020
Last Update Date	:	01/25/2020

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