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General NPI Number Information
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NPI Number | 1053682096
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Entity Type | Individual
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Provider Name | LETITIA JANETTE BURAGE RPH
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 370 SCHILLINGER RD S
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City | MOBILE
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State | AL
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Zip | 36695-8960
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Country | US
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Telephone | 251-776-6347
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 AUGUSTA DR W
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City | MOBILE
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State | AL
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Zip | 36695-9274
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Country | US
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Telephone | 251-776-7203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13778
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License Number State | AL
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