Healthcare Provider Details

I. General information

NPI: 1205828027
Provider Name (Legal Business Name): JENA IVEY BURKHART PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CB 7574 BEARD HALL 115H SCHOOL OF PHARMACY
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

104 TEAGAN CT
CHAPEL HILL NC
27516-4372
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-2626
  • Fax: 919-962-0644
Mailing address:
  • Phone: 919-966-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17232
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: