Provider Demographics
NPI:1245894682
Name:BURKE CENTER
Entity type:Organization
Organization Name:BURKE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIESCHANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-634-5664
Mailing Address - Street 1:2704 HOMER ALTO RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-8750
Mailing Address - Country:US
Mailing Address - Phone:936-634-5664
Mailing Address - Fax:936-634-5854
Practice Address - Street 1:1522 W FRANK AVE STE 109
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3334
Practice Address - Country:US
Practice Address - Phone:936-630-3700
Practice Address - Fax:936-634-0110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURKE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy