Provider Demographics
NPI:1871835280
Name:BURKETT, MARY CATHERINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 ENVOY CT
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-2560
Mailing Address - Country:US
Mailing Address - Phone:727-709-4549
Mailing Address - Fax:727-479-3047
Practice Address - Street 1:501 S LINCOLN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5945
Practice Address - Country:US
Practice Address - Phone:727-479-3048
Practice Address - Fax:727-479-3047
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29426183500000X
PARP-037946-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist