Provider Demographics
NPI:1467175117
Name:BURKE, ELIZABETH ANN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MILE 3 RD
Mailing Address - Street 2:
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-6677
Mailing Address - Country:US
Mailing Address - Phone:956-519-2240
Mailing Address - Fax:956-519-2746
Practice Address - Street 1:215 E MILE 3 RD
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-6677
Practice Address - Country:US
Practice Address - Phone:956-519-2240
Practice Address - Fax:956-519-2746
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168220183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician