Healthcare Provider Details

I. General information

NPI: 1720401920
Provider Name (Legal Business Name): THOMAS BURRUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 S LONG DR
ROCKINGHAM NC
28379-4815
US

IV. Provider business mailing address

118 PINE ST
CARRBORO NC
27510-1342
US

V. Phone/Fax

Practice location:
  • Phone: 910-997-3137
  • Fax:
Mailing address:
  • Phone: 919-672-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: