Provider Demographics
NPI:1982207197
Name:BURKE, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BURKE
Suffix:
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 1:1187 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-1074
Mailing Address - Country:US
Mailing Address - Phone:401-539-4000
Mailing Address - Fax:
Practice Address - Street 1:1187 MAINT ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-539-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI3798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist