Provider Demographics
NPI:1215517362
Name:BURRY, JAMES ALBERT III (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:BURRY
Suffix:III
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 1:500 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5019
Mailing Address - Country:US
Mailing Address - Phone:352-787-3787
Mailing Address - Fax:352-787-6926
Practice Address - Street 1:500 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5019
Practice Address - Country:US
Practice Address - Phone:352-787-3787
Practice Address - Fax:352-787-6926
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist