MEDICARE: KIM BURKES RPH, BCNP

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	21631	WA
2	1835N0905X	Nuclear Pharmacist	21631	WA

General Provider Information

NPI Number	:	1598985921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM BURKES RPH, BCNP

Provider Business Mailing Address
First Line	:	1912 N PUGET SOUND AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98406-5844
Country	:	US
Telephone Number	:	253-752-1705
Fax Number	:	253-761-9315

Provider Business Practice Location Address
First Line	:	2302 S UNION AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-1705
Fax Number	:	253-761-9315

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	05/22/2010

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