Provider Demographics
NPI:1023454196
Name:BURRELL, AMY H (RHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:BURRELL
Suffix:
Gender:F
Credentials:RHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SHORT DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-1411
Mailing Address - Country:US
Mailing Address - Phone:662-257-4748
Mailing Address - Fax:
Practice Address - Street 1:1310 SHORT DR
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-1411
Practice Address - Country:US
Practice Address - Phone:662-257-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist