Provider Demographics
NPI:1851527790
Name:BURGE, JOHN WARREN (RPH, MHS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:BURGE
Suffix:
Gender:M
Credentials:RPH, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10877 S CARBONDALE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5128
Mailing Address - Country:US
Mailing Address - Phone:816-435-2322
Mailing Address - Fax:
Practice Address - Street 1:1300 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1416
Practice Address - Country:US
Practice Address - Phone:816-435-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-09744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist