Provider Demographics
NPI:1518992825
Name:BURKS, CHAD E (PHARMD, MBA, MSMIT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:BURKS
Suffix:
Gender:M
Credentials:PHARMD, MBA, MSMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 QUAIL RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9657
Mailing Address - Country:US
Mailing Address - Phone:502-599-1021
Mailing Address - Fax:
Practice Address - Street 1:2750 ALLISON LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5900
Practice Address - Country:US
Practice Address - Phone:812-218-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015672183500000X
IN26024277A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY015672OtherKENTUCKY LICENSE
IN26024277AOtherINDIANA LICENSE