Provider Demographics
NPI:1023461662
Name:BURKE, KERRI (CPHT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-7200
Mailing Address - Country:US
Mailing Address - Phone:541-883-2947
Mailing Address - Fax:541-883-6104
Practice Address - Street 1:2909 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7200
Practice Address - Country:US
Practice Address - Phone:541-883-2947
Practice Address - Fax:541-883-6104
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician