Healthcare Provider Details

I. General information

NPI: 1497461123
Provider Name (Legal Business Name): LAURA MARIE FERNANDEZ BURGOS PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 INDIAN HEALTH RD
PINE RIDGE SD
57770-3169
US

IV. Provider business mailing address

PO BOX 1708
PINE RIDGE SD
57770-1708
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-3093
  • Fax:
Mailing address:
  • Phone: 786-812-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8353
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: