Provider Demographics
NPI:1366566838
Name:BURKE, JAMES CONRAD (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CONRAD
Last Name:BURKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1364
Mailing Address - Country:US
Mailing Address - Phone:724-348-8158
Mailing Address - Fax:724-348-8158
Practice Address - Street 1:2003 SHEFFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2758
Practice Address - Country:US
Practice Address - Phone:724-375-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032893L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist