Provider Demographics
NPI:1235273566
Name:BUERKLE, EDWARD (PD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BUERKLE
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-4355
Mailing Address - Country:US
Mailing Address - Phone:870-673-3784
Mailing Address - Fax:870-673-3685
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-4355
Practice Address - Country:US
Practice Address - Phone:870-673-3784
Practice Address - Fax:870-673-3685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49328Medicare ID - Type Unspecified