Healthcare Provider Details

I. General information

NPI: 1760869028
Provider Name (Legal Business Name): KAYLA WREN BURNS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E MAIN ST
HART MI
49420-1190
US

IV. Provider business mailing address

611 E MAIN ST
HART MI
49420-1190
US

V. Phone/Fax

Practice location:
  • Phone: 231-873-6922
  • Fax: 231-873-1825
Mailing address:
  • Phone: 231-873-6922
  • Fax: 231-873-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302039395
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302039395
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: