Healthcare Provider Details

I. General information

NPI: 1366324196
Provider Name (Legal Business Name): ELAINA RENEE BURTON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 JACKMAN RD
TOLEDO OH
43613-3574
US

IV. Provider business mailing address

9328 SAINT ANGELAS WAY
SYLVANIA OH
43560-8975
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-9103
  • Fax: 419-474-2192
Mailing address:
  • Phone: 419-250-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: