Healthcare Provider Details

I. General information

NPI: 1740981000
Provider Name (Legal Business Name): KATELYN BURTON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

330 PARK WAY APT B
NORTH POLE AK
99705-6022
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number198289
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: