Provider Demographics
NPI:1568055390
Name:BURKE, AARON EDWARD
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:EDWARD
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13545 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:MI
Mailing Address - Zip Code:48137-9683
Mailing Address - Country:US
Mailing Address - Phone:313-942-5295
Mailing Address - Fax:
Practice Address - Street 1:110 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285-9148
Practice Address - Country:US
Practice Address - Phone:517-851-7575
Practice Address - Fax:517-851-9295
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315114911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist