Healthcare Provider Details

I. General information

NPI: 1568445021
Provider Name (Legal Business Name): ELISA G. BURTON RPH, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 COLONY RD RT 210 EAST
MADISON HEIGHTS VA
24572-2105
US

IV. Provider business mailing address

212 MILL LANE RD
LYNCHBURG VA
24503-1706
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-2081
  • Fax:
Mailing address:
  • Phone: 434-947-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202007399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: