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General NPI Number Information
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NPI Number | 1265449706
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Entity Type | Individual
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Provider Name | JOHNNY WAYNE BURKETT RPH
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 102 GREENVILLE ROAD
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City | NORTONVILLE
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State | KY
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Zip | 42442
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Country | US
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Telephone | 270-676-8268
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Fax | 270-676-8205
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Provider Business Mailing Address
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Address Line | 134 RIDGEWOOD LN
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City | GREENVILLE
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State | KY
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Zip | 42345-4562
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Country | US
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Telephone | 270-338-5764
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Fax | 270-676-8205
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 006708
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License Number State | KY
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