Provider Demographics
NPI:1285945063
Name:BURKE, LARISA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LINDEN TREE LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7232
Mailing Address - Country:US
Mailing Address - Phone:302-588-3663
Mailing Address - Fax:
Practice Address - Street 1:728 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6029
Practice Address - Country:US
Practice Address - Phone:410-398-9595
Practice Address - Fax:410-398-8179
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18334183500000X
DEA1-0003887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist