=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306446943
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID BURTON PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2020
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 WALMART PLAZA DR
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42633-7934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-348-3333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3009
-----------------------------------------------------
City | WEST SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42564-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 014574
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------