Provider Demographics
NPI:1538491014
Name:BURBANK, JEFFREY L (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:BURBANK
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 1:490 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-998-8000
Mailing Address - Fax:718-375-1282
Practice Address - Street 1:490 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2002
Practice Address - Country:US
Practice Address - Phone:718-998-8000
Practice Address - Fax:718-375-1282
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist