Provider Demographics
NPI:1386364131
Name:BURCH, MARY ALISON (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALISON
Last Name:BURCH
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 1:1484 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4626
Mailing Address - Country:US
Mailing Address - Phone:843-373-3144
Mailing Address - Fax:
Practice Address - Street 1:8910 OLD NUMBER SIX HWY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:SC
Practice Address - Zip Code:29142-8607
Practice Address - Country:US
Practice Address - Phone:803-854-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist