Provider Demographics
NPI:1649663543
Name:BURKE, MARLIA (RPH)
Entity type:Individual
Prefix:
First Name:MARLIA
Middle Name:
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 1:960 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-2225
Mailing Address - Country:US
Mailing Address - Phone:239-354-9770
Mailing Address - Fax:
Practice Address - Street 1:1757 SAN MARCO RD UNIT B
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5151
Practice Address - Country:US
Practice Address - Phone:239-970-0415
Practice Address - Fax:239-970-0649
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist