Healthcare Provider Details

I. General information

NPI: 1285685289
Provider Name (Legal Business Name): JACQUELYN MARIE BURRELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 W LEXINGTON AVE
WINCHESTER KY
40391-1169
US

IV. Provider business mailing address

360 ARNOLD LN
CYNTHIANA KY
41031-7748
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-3470
  • Fax: 859-745-3452
Mailing address:
  • Phone: 859-234-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010549
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: