Healthcare Provider Details

I. General information

NPI: 1427962067
Provider Name (Legal Business Name): DOMINIQUE ANN BURCHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

904 RED CLIFF DR
AUSTIN TX
78758-5123
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0148
  • Fax:
Mailing address:
  • Phone: 512-324-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019042069
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: