Provider Demographics
NPI:1720277304
Name:MCBURROWS, NIESHA NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:NIESHA
Middle Name:NICOLE
Last Name:MCBURROWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NIESHA
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2363 SEBAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-8008
Mailing Address - Country:US
Mailing Address - Phone:863-606-5248
Mailing Address - Fax:
Practice Address - Street 1:4237 S PIPKIN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1442
Practice Address - Country:US
Practice Address - Phone:863-701-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist