Individual
RANDALL BURT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 S 108TH ST, T-2199, WEST ALLIS, WI 53227-1926
(414) 545-0385
Mailing address
2600 S 108TH ST, T-2199, WEST ALLIS, WI 53227-1926
(414) 545-0385
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12954-40
WI
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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