Provider Demographics
NPI:1639551484
Name:BURKE, CECIL RAYMOND III
Entity Type:Individual
Prefix:MR
First Name:CECIL
Middle Name:RAYMOND
Last Name:BURKE
Suffix:III
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 1:301 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-1834
Mailing Address - Country:US
Mailing Address - Phone:252-566-9595
Mailing Address - Fax:252-566-0336
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-1834
Practice Address - Country:US
Practice Address - Phone:252-566-9595
Practice Address - Fax:252-566-0336
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist