Provider Demographics
NPI:1396484648
Name:BURGER, MARK LOUIS (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:BURGER
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 1:1440 MELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8402
Mailing Address - Country:US
Mailing Address - Phone:630-715-6258
Mailing Address - Fax:
Practice Address - Street 1:1440 MELBOURNE ST
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8402
Practice Address - Country:US
Practice Address - Phone:630-715-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051039256OtherRPH LICENSE NUMBER