Provider Demographics
NPI:1386153336
Name:BURGESS, NATALIE ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ANN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:IL
Mailing Address - Zip Code:61864-9754
Mailing Address - Country:US
Mailing Address - Phone:262-358-5699
Mailing Address - Fax:
Practice Address - Street 1:2500 PHILO RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-8044
Practice Address - Country:US
Practice Address - Phone:217-365-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist