Healthcare Provider Details

I. General information

NPI: 1982959417
Provider Name (Legal Business Name): RAYMOND FRANK BURZYNSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 MATTHEWS MINT HILL RD
MATTHEWS NC
28105-3605
US

IV. Provider business mailing address

2903 N DAVIDSON ST APT. 2045
CHARLOTTE NC
28205-1096
US

V. Phone/Fax

Practice location:
  • Phone: 704-708-5701
  • Fax:
Mailing address:
  • Phone: 989-370-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: