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General NPI Number Information
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NPI Number | 1245894682
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Entity Type | Organization
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Legal Business Name | BURKE CENTER
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 1522 W FRANK AVE STE 109
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City | LUFKIN
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State | TX
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Zip | 75904-3334
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Country | US
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Telephone | 936-630-3700
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Fax | 936-634-0110
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Provider Business Mailing Address
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Address Line | 2704 HOMER ALTO RD
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City | LUFKIN
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State | TX
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Zip | 75904-8750
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Country | US
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Telephone | 936-634-5664
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Fax | 936-634-5854
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | TED ZIESCHANG
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Credential | RPH
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Telephone | 936-634-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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