Amy Bartley Burghardt, PHARMD
Individual provider Active NPI Pharmacist · Locust Grove, GA
NPI 1710225933 · NPPES record last updated Jan 23, 2013
Key facts
- NPI
- 1710225933
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 021699 (GA)
- Practice address
- 2730 Highway 155
Locust Grove, GA 30248-2401 - Phone
- (770) 288-4186
- NPI assigned
- Jan 23, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021699 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients | |
| Publix Super Markets Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021699 | GA | Yes |
Addresses
Primary practice location
2730 Highway 155
Locust Grove, GA 30248-2401
Mailing address
1260 McAllistar Dr
Locust Grove, GA 30248-2480
Phone (770) 898-6740
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021699 | Other | GA | GA STATE BOARD OF PHARMACY |
Other providers in Locust Grove, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.