MEDICARE: JEFFREY FRANCIS BURKE

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	PCT0008389	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PCT0008389	OTHER	CT	PHARMACY REGISTRATION

General Provider Information

NPI Number	:	1891218996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY FRANCIS BURKE

Provider Business Mailing Address
First Line	:	1138 BLOSSOM ST
Second Line	:
City	:	SUFFIELD
State	:	CT
Zip	:	06078-1052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SALMON BROOK ST
Second Line	:
City	:	GRANBY
State	:	CT
Zip	:	06035-2604
Country	:	US
Telephone Number	:	860-844-8346
Fax Number	:	860-844-8346

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

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	06/16/2018

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