Individual
MIKAYLA NICOLE BURDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
323 S WALKER ST, PRINCETON, WV 24740-2756
(304) 431-4967
(304) 431-5405
Mailing address
48 THISTLE HOLLOW RD, LINDSIDE, WV 24951-7035
(304) 646-8987
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0011743
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0011743
PHARMACIST
WV
Enumeration date
09/17/2019
Last updated
12/15/2019
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