Provider Demographics
NPI:1346397932
Name:BURKE, MICHAEL CLARK (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLARK
Last Name:BURKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 W VERADA DEL VENADO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9767
Mailing Address - Country:US
Mailing Address - Phone:520-743-9657
Mailing Address - Fax:
Practice Address - Street 1:10661 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9322
Practice Address - Country:US
Practice Address - Phone:520-742-6667
Practice Address - Fax:520-742-2694
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ6604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist