Healthcare Provider Details

I. General information

NPI: 1497667109
Provider Name (Legal Business Name): JAYLA BURWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 SPRING FOREST RD
RALEIGH NC
27615-7528
US

IV. Provider business mailing address

1620 CRYSTAL CREEK DR
DURHAM NC
27712-2484
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-6401
  • Fax:
Mailing address:
  • Phone: 919-724-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35030
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: