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General NPI Number Information
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NPI Number | 1689062671
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Entity Type | Individual
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Provider Name | LESTER BURRIS II
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Gender | Male
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 2424 S WALNUT ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7730
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Country | US
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Telephone | 812-287-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 3029 RIVER BLUFF RD
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City | BEDFORD
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State | IN
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Zip | 47421-9143
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Country | US
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Telephone |
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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 | 26024493A
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License Number State | IN
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