Provider Demographics
NPI:1902932882
Name:BURKE, DAVID EDMUND (RPH, MBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDMUND
Last Name:BURKE
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1019
Mailing Address - Country:US
Mailing Address - Phone:937-644-1322
Mailing Address - Fax:937-644-2360
Practice Address - Street 1:411 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1019
Practice Address - Country:US
Practice Address - Phone:937-644-1322
Practice Address - Fax:937-644-2360
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist