Healthcare Provider Details

I. General information

NPI: 1134023278
Provider Name (Legal Business Name): ALISSA DANIELLE BURRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TRENTON ST
RUSTON LA
71270-2325
US

IV. Provider business mailing address

2301 TIMBERLINE CT APT E106
RUSTON LA
71270-5289
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-8731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.026461
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: