Provider Demographics
NPI:1386240703
Name:BURNS, JOHN W (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BURNS
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 1:453 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1127
Mailing Address - Country:US
Mailing Address - Phone:608-515-3408
Mailing Address - Fax:
Practice Address - Street 1:11134N STATE HIGHWAY 77
Practice Address - Street 2:SUITE A
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5325
Practice Address - Country:US
Practice Address - Phone:715-634-6774
Practice Address - Fax:715-634-5517
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist