Provider Demographics
NPI:1871320614
Name:BURNS, PHILLIP JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JAMES
Last Name:BURNS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 PULPWOOD YARD RD
Mailing Address - Street 2:
Mailing Address - City:PEACHLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28133-9360
Mailing Address - Country:US
Mailing Address - Phone:704-690-5116
Mailing Address - Fax:
Practice Address - Street 1:3310 SISKEY PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3222
Practice Address - Country:US
Practice Address - Phone:704-849-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist