Provider Demographics
NPI:1215376264
Name:BURLEY, STEVEN ALEXANDER
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALEXANDER
Last Name:BURLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32915 SE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-6709
Mailing Address - Country:US
Mailing Address - Phone:425-444-2345
Mailing Address - Fax:
Practice Address - Street 1:5700 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8914
Practice Address - Country:US
Practice Address - Phone:425-391-6408
Practice Address - Fax:425-392-2127
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60661795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist