Provider Demographics
NPI:1043593031
Name:BURKE, JEFFREY ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
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 1:881 SMITHONIA RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-2404
Mailing Address - Country:US
Mailing Address - Phone:706-742-7217
Mailing Address - Fax:
Practice Address - Street 1:18 COLLEGE AVE.
Practice Address - Street 2:WALGREENS #11166
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635
Practice Address - Country:US
Practice Address - Phone:706-283-8228
Practice Address - Fax:706-283-8295
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist