Provider Demographics
NPI:1265020978
Name:BURKY, COLLEEN MARY (RPH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:BURKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 WEXFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3217
Mailing Address - Country:US
Mailing Address - Phone:614-288-1023
Mailing Address - Fax:
Practice Address - Street 1:5200 WESTPOINTE PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9126
Practice Address - Country:US
Practice Address - Phone:614-876-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist