Healthcare Provider Details

I. General information

NPI: 1376457242
Provider Name (Legal Business Name): MICHAEL JOSEPH BURCHMORE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 JUNIPER RD
SUN VALLEY ID
83353
US

IV. Provider business mailing address

319 JUNIPER RD
SUN VALLEY ID
83353
US

V. Phone/Fax

Practice location:
  • Phone: 208-721-2685
  • Fax: 208-806-1231
Mailing address:
  • Phone: 208-721-2685
  • Fax: 208-806-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH43873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: