Provider Demographics
NPI:1992350664
Name:BURTON, CARLY JAN (PHARMD, CDE)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:JAN
Last Name:BURTON
Suffix:
Gender:F
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 NE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-2648
Mailing Address - Country:US
Mailing Address - Phone:816-905-3443
Mailing Address - Fax:
Practice Address - Street 1:2612 NE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64117-2648
Practice Address - Country:US
Practice Address - Phone:169-053-4438
Practice Address - Fax:866-739-1839
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty