Provider Demographics
NPI:1255961272
Name:BURKE, CHRISTIAN TYLER (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:TYLER
Last Name:BURKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:NEON
Mailing Address - State:KY
Mailing Address - Zip Code:41840-1073
Mailing Address - Country:US
Mailing Address - Phone:606-634-7155
Mailing Address - Fax:
Practice Address - Street 1:350 WHITESBURG PLAZA
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858
Practice Address - Country:US
Practice Address - Phone:606-633-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty