MEDICARE: BERNARD BURY SR.

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	03120954	OH

General Provider Information

NPI Number	:	1730505108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD BURY SR.

Provider Business Mailing Address
First Line	:	1170 KAMES WAY DR
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9561
Country	:	US
Telephone Number	:	614-507-5243
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 KAMES WAY DR
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9561
Country	:	US
Telephone Number	:	614-507-5243
Fax Number	:

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

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	03/10/2014

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Directions to “ BERNARD BURY SR. ” Practice Location

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