Healthcare Provider Details

I. General information

NPI: 1053312793
Provider Name (Legal Business Name): LAURA LYNN BURCHAM PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 IRONBOUND RD EASTERN STATE HOSPITAL
WILLIAMSBURG VA
23188-2652
US

IV. Provider business mailing address

9727 OLD STAGE RD
TOANO VA
23168
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5327
  • Fax: 757-253-4521
Mailing address:
  • Phone: 757-566-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230002209
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: