MEDICARE: TYRONE BURRISON PHARMD.

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	PH100001767	DC
2	183500000X	Pharmacist	22580	MD

General Provider Information

NPI Number	:	1912308131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE BURRISON PHARMD.

Provider Business Mailing Address
First Line	:	7401 NEW HAMPSHIRE AVE
Second Line	:	APT #420
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4635 S CAPITOL ST SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-2717
Country	:	US
Telephone Number	:	202-561-0939
Fax Number	:

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

Provider Enumeration Date	:	09/07/2014
Last Update Date	:	09/22/2014

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