MEDICARE: DR. CARLY JAN BURTON PHARMD, CDE

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	2013026233	MO

General Provider Information

NPI Number	:	1992350664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLY JAN BURTON PHARMD, CDE

Provider Business Mailing Address
First Line	:	2612 NE INDUSTRIAL DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-2648
Country	:	US
Telephone Number	:	816-905-3443
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 NE INDUSTRIAL DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64117-2648
Country	:	US
Telephone Number	:	169-053-4438
Fax Number	:	866-739-1839

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

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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