Provider Demographics
NPI:1639401300
Name:BURKE, JOHN PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:BURKE
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 1:435 E HENRIETTA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4629
Mailing Address - Country:US
Mailing Address - Phone:585-760-6108
Mailing Address - Fax:585-760-6113
Practice Address - Street 1:435 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4629
Practice Address - Country:US
Practice Address - Phone:585-760-6108
Practice Address - Fax:585-760-6113
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist