Basic Information
| Provider Information | |||||||||
| NPI: | 1275821472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHARMD, BCACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 S 38TH AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099651035 | ||||||||
| FaxNumber: | 5092252700 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 S 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092495717 | ||||||||
| FaxNumber: | 5092252715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2011 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | PH00051603 | WA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.