Healthcare Provider Details

I. General information

NPI: 1215189394
Provider Name (Legal Business Name): TOMMY BURNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6668 DUNSDIN DR
PLAINFIELD IN
46168-7542
US

IV. Provider business mailing address

6668 DUNSDIN DR
PLAINFIELD IN
46168-7542
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-5043
  • Fax:
Mailing address:
  • Phone: 317-529-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number67013829A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: