=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053655423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY M BURKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2012
-----------------------------------------------------
Last Update Date | 11/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 ELLIOTT ST
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01915-3359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-921-0506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 CHERRY ST
-----------------------------------------------------
City | GLOUCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01930-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-290-7682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | PT1150
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------