Provider Demographics
NPI:1962862961
Name:BURRIS, ROBIN (RPH)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1730
Mailing Address - Country:US
Mailing Address - Phone:901-872-0167
Mailing Address - Fax:901-872-0176
Practice Address - Street 1:8039 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1730
Practice Address - Country:US
Practice Address - Phone:901-872-0167
Practice Address - Fax:901-872-0176
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39408183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39408OtherTENNESSEE PHARMACY LICENSE