Healthcare Provider Details

I. General information

NPI: 1255574539
Provider Name (Legal Business Name): BRANDON REID BURKHOLDER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 WAYNESBURG DR SE
WAYNESBURG OH
44688-9549
US

IV. Provider business mailing address

16495 FREED ST SE
MINERVA OH
44657-9106
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-5020
  • Fax: 330-866-9096
Mailing address:
  • Phone: 330-868-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-28034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: