Provider Demographics
NPI:1992306286
Name:BURRIS, ASHLEY DANIELLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 W PONTOON RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6848
Mailing Address - Country:US
Mailing Address - Phone:618-451-6002
Mailing Address - Fax:618-451-0454
Practice Address - Street 1:379 W PONTOON RD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6848
Practice Address - Country:US
Practice Address - Phone:618-451-6002
Practice Address - Fax:618-451-0454
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014026312183500000X
IL051297835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist