Individual
MS. LORI TEWKSBURY BURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH, CGP
Contact information
Practice address
500 N US HIGHWAY 89, PRESCOTT, AZ 86313-5001
(928) 445-4860
Mailing address
PO BOX 9041, PRESCOTT, AZ 86313-9041
(928) 445-4860
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
S007469
AZ
1835G0303X
Geriatric Pharmacist
Primary
S007469
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S007469
PHARMACY LICENSE
AZ
Enumeration date
03/18/2011
Last updated
03/18/2011
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