Healthcare Provider Details

I. General information

NPI: 1538421649
Provider Name (Legal Business Name): JEAN MARIE BUERKLE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 8TH AVE
CONWAY PA
15027-1306
US

IV. Provider business mailing address

908 8TH AVE
CONWAY PA
15027-1306
US

V. Phone/Fax

Practice location:
  • Phone: 724-869-0904
  • Fax:
Mailing address:
  • Phone: 724-869-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP037301L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: