MEDICARE: MR. WOODWARD ELLIOTT BURBANK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20790	MI

General Provider Information

NPI Number	:	1316237670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WOODWARD ELLIOTT BURBANK RPH

Provider Business Mailing Address
First Line	:	5829 PATRICIA LN
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 SPRING ARBOR RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2701
Country	:	US
Telephone Number	:	517-789-6630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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