Healthcare Provider Details

I. General information

NPI: 1740271246
Provider Name (Legal Business Name): DEWEY ALDON BURDINE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 BOILING SPRINGS RD
SPARTANBURG SC
29303-2258
US

IV. Provider business mailing address

317 WOODGROVE TRCE
SPARTANBURG SC
29301-6433
US

V. Phone/Fax

Practice location:
  • Phone: 800-494-7127
  • Fax:
Mailing address:
  • Phone: 864-576-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4585
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: