Individual
MARCUS BLAKE BURCHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
902 S GLOSTER ST, TUPELO, MS 38801-6312
(662) 844-1318
Mailing address
294 FRIENDSHIP RD, ECRU, MS 38841-9649
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-15058
MS
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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