Provider Demographics
NPI:1396759718
Name:PURKO, RICK STEPHEN (RPH)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:STEPHEN
Last Name:PURKO
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:ZABLOCKI VA MEDICAL CTR
Mailing Address - Street 2:5000 WEST NATIONAL AVENUE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-384-2000
Mailing Address - Fax:414-389-4276
Practice Address - Street 1:ZABLOCKI VA MEDICAL CTR
Practice Address - Street 2:5000 WEST NATIONAL AVENUE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-389-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI12274-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist