Provider Demographics
NPI:1205945060
Name:BURRIS, SCOTT E (RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:BURRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14667 HIGHWAY 119 S
Mailing Address - Street 2:
Mailing Address - City:PARTRIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:40862-6447
Mailing Address - Country:US
Mailing Address - Phone:606-589-2717
Mailing Address - Fax:606-633-0222
Practice Address - Street 1:93 ISOM PLAZA
Practice Address - Street 2:
Practice Address - City:ISOM
Practice Address - State:KY
Practice Address - Zip Code:41824
Practice Address - Country:US
Practice Address - Phone:606-633-9238
Practice Address - Fax:606-633-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10486OtherSTATE LICENSE