MEDICARE: MS. JACQUELYN MARIE BURRELL PHARM.D.

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	183500000X	Pharmacist	010549	KY

General Provider Information

NPI Number	:	1285685289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELYN MARIE BURRELL PHARM.D.

Provider Business Mailing Address
First Line	:	360 ARNOLD LN
Second Line	:
City	:	CYNTHIANA
State	:	KY
Zip	:	41031-7748
Country	:	US
Telephone Number	:	859-234-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 W LEXINGTON AVE
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1169
Country	:	US
Telephone Number	:	859-745-3470
Fax Number	:	859-745-3452

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

Provider Enumeration Date	:	05/14/2006
Last Update Date	:	07/08/2007

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