Provider Demographics
NPI:1750717146
Name:BURKE, SUSAN LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEE
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 1:10000 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4803
Mailing Address - Country:US
Mailing Address - Phone:623-907-5662
Mailing Address - Fax:
Practice Address - Street 1:10000 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4803
Practice Address - Country:US
Practice Address - Phone:623-907-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist