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General NPI Number Information
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NPI Number | 1922656719
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Entity Type | Individual
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Provider Name | CHRISTOPHER BURGESS
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Gender | Male
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 2715 NACHES AVE SW
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City | RENTON
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State | WA
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Zip | 98057-2627
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Country | US
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Telephone | 206-630-7910
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Fax |
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Provider Business Mailing Address
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Address Line | 2603 BOYLSTON AVE E APT 1
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City | SEATTLE
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State | WA
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Zip | 98102-3236
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Country | US
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Telephone | 407-832-0903
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PSI40233
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | IR60690612
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License Number State | WA
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