=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376457242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOSEPH BURCHMORE PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2026
-----------------------------------------------------
Last Update Date | 09/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 JUNIPER RD
-----------------------------------------------------
City | SUN VALLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-721-2685
-----------------------------------------------------
Fax | 208-806-1231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 JUNIPER RD
-----------------------------------------------------
City | SUN VALLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-721-2685
-----------------------------------------------------
Fax | 208-806-1231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835X0200X
-----------------------------------------------------
Taxonomy Name | Oncology Pharmacist
-----------------------------------------------------
License Number | RPH43873
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------