Healthcare Provider Details

I. General information

NPI: 1396940516
Provider Name (Legal Business Name): ELIZABETH M BURNS PHARMACY TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27278 STATE HWY 18
GARRISON MN
56450
US

IV. Provider business mailing address

27278 STATE HWY 18 PO BOX 426
GARRISON MN
56450
US

V. Phone/Fax

Practice location:
  • Phone: 320-525-3401
  • Fax:
Mailing address:
  • Phone: 320-525-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number705706
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: