Provider Demographics
NPI:1154539336
Name:BUROKER, D JACK (R PH)
Entity type:Individual
Prefix:MR
First Name:D
Middle Name:JACK
Last Name:BUROKER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-2011
Mailing Address - Country:US
Mailing Address - Phone:419-675-2575
Mailing Address - Fax:419-674-4098
Practice Address - Street 1:981 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1650
Practice Address - Country:US
Practice Address - Phone:419-675-2705
Practice Address - Fax:419-674-4098
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-07629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist