Provider Demographics
NPI:1689951188
Name:BURCH, JANELLE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:M
Last Name:BURCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 S STONEGATE CIR
Mailing Address - Street 2:APT 202
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4581
Mailing Address - Country:US
Mailing Address - Phone:414-443-9414
Mailing Address - Fax:
Practice Address - Street 1:8333 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4441
Practice Address - Country:US
Practice Address - Phone:414-443-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15496-40183500000X
FLPS41414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist