MEDICARE: DR. JENA IVEY BURKHART PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	17232	NC

General Provider Information

NPI Number	:	1205828027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENA IVEY BURKHART PHARMD

Provider Business Mailing Address
First Line	:	104 TEAGAN CT
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4372
Country	:	US
Telephone Number	:	919-966-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	CB 7574 BEARD HALL 115H
Second Line	:	SCHOOL OF PHARMACY
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-966-2626
Fax Number	:	919-962-0644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	04/23/2013

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