Provider Demographics
NPI:1487948410
Name:BURRIS, ROBIN L (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:L
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 1:24890 N LAKE PLEASANT PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1348
Mailing Address - Country:US
Mailing Address - Phone:623-376-7301
Mailing Address - Fax:
Practice Address - Street 1:24890 N LAKE PLEASANT PKWY
Practice Address - Street 2:T2227
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1348
Practice Address - Country:US
Practice Address - Phone:623-376-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist