Provider Demographics
NPI:1295850832
Name:BURKHART, MICHAEL J (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BURKHART
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 1:5756 CEDARIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7415
Mailing Address - Country:US
Mailing Address - Phone:513-574-8699
Mailing Address - Fax:
Practice Address - Street 1:305 MARY GRUBBS HWY
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-7483
Practice Address - Country:US
Practice Address - Phone:859-485-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist