=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932146743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID JAMES BURISH RPH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 S 18TH AVE
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54401-4252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-842-3541
-----------------------------------------------------
Fax | 715-845-5306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 NUTHATCH LN
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54401-9130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-842-4811
-----------------------------------------------------
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 | 9744-040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------