Active NPI
Bruce Brooksbank Burdeshaw, RPH
- Pharmacist
- Marietta, GA
National Provider Identifier
1669620001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 09359
- Practice address
- 731 Whitlock Ave SW
Marietta, GA 30064-3033 - Phone
- (770) 427-8155
- NPI assigned
- Aug 27, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 09359 | GA | Primary |
Addresses
Primary practice location
731 Whitlock Ave SW
Marietta, GA 30064-3033
Mailing address
731 Whitlock Ave SW
Marietta, GA 30064-3033
Phone (770) 427-8155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09359 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1669620001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 WHITLOCK AVE SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643033",
"telephone_number": "770-427-8155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "731 WHITLOCK AVE SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643033",
"telephone_number": "770-427-8155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURDESHAW",
"first_name": "BRUCE",
"middle_name": "BROOKSBANK",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-27",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "09359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.