Provider Demographics
NPI:1295913911
Name:BURKE, AMELIA LOUISE (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:LOUISE
Last Name:BURKE
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 1:7644 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8928
Mailing Address - Country:US
Mailing Address - Phone:585-924-0768
Mailing Address - Fax:
Practice Address - Street 1:2580 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4526
Practice Address - Country:US
Practice Address - Phone:585-321-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050057-1183500000X
WI10245-040183500000X
MI5302025643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist