Provider Demographics
NPI:1841888625
Name:BURKE, LUCY ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:ANN
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 1:341 PLYMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338
Mailing Address - Country:US
Mailing Address - Phone:781-293-5786
Mailing Address - Fax:844-411-6221
Practice Address - Street 1:341 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:MA
Practice Address - Zip Code:02338
Practice Address - Country:US
Practice Address - Phone:781-293-5786
Practice Address - Fax:844-411-6221
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24792333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy