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General NPI Number Information
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NPI Number | 1801179080
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Entity Type | Individual
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Provider Name | GINA MARIE BURTNESS RPH
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 10211 CHESTNUT PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-8970
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Country | US
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Telephone | 260-625-4831
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Fax | 260-625-5061
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Provider Business Mailing Address
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Address Line | 2918 SETTLEMENT CREEK RUN
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City | FORT WAYNE
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State | IN
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Zip | 46804-6039
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Country | US
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Telephone | 260-432-0195
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Fax | 260-625-5061
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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 | 26016420A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS25364
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License Number State | FL
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