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NPI Code Detail

MEDICARE: MRS. ELISA G. BURTON RPH, BCPP

MEDICARE:  MRS. ELISA G. BURTON  RPH, BCPP
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
11835P1300XPsychiatric Pharmacist0202007399VA

General Provider Information

NPI Number : 1568445021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELISA G. BURTON RPH, BCPP
Provider Business Mailing Address
First Line : 212 MILL LANE RD
Second Line :
City : LYNCHBURG
State : VA
Zip : 24503-1706
Country : US
Telephone Number : 434-947-2081
Fax Number :
Provider Business Practice Location Address
First Line : 521 COLONY RD
Second Line : RT 210 EAST
City : MADISON HEIGHTS
State : VA
Zip : 24572-2105
Country : US
Telephone Number : 434-947-2081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/08/2007

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