Provider Demographics
NPI:1407158280
Name:BURKE, ROSEANNE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:MARIE
Last Name:BURKE
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 1:3865 DANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2129
Mailing Address - Country:US
Mailing Address - Phone:757-416-5931
Mailing Address - Fax:
Practice Address - Street 1:205 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2504
Practice Address - Country:US
Practice Address - Phone:757-587-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009936183500000X
NY134971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist