Provider Demographics
NPI:1114616729
Name:BURK, JENELL MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENELL
Middle Name:MARIE
Last Name:BURK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 ELDER AVE STE 8/9
Mailing Address - Street 2:
Mailing Address - City:SAND CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3547
Mailing Address - Country:US
Mailing Address - Phone:831-383-5040
Mailing Address - Fax:831-383-5045
Practice Address - Street 1:495 ELDER AVE STE 8/9
Practice Address - Street 2:
Practice Address - City:SAND CITY
Practice Address - State:CA
Practice Address - Zip Code:93955-3547
Practice Address - Country:US
Practice Address - Phone:831-383-5040
Practice Address - Fax:831-383-5045
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist