=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366324196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINA RENEE BURTON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2025
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 E AIRPORT HWY
-----------------------------------------------------
City | SWANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43558-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-825-1475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9328 SAINT ANGELAS WAY
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-8975
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-250-7235
-----------------------------------------------------
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 | 03443487
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------