Provider Demographics
NPI:1568445021
Name:BURTON, ELISA G (RPH, BCPP)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:G
Last Name:BURTON
Suffix:
Gender:F
Credentials:RPH, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MILL LANE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-1706
Mailing Address - Country:US
Mailing Address - Phone:434-947-2081
Mailing Address - Fax:
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:RT 210 EAST
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-2081
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020073991835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric