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General NPI Number Information
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NPI Number | 1699051714
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Entity Type | Individual
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Provider Name | TROY BURKE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 10686 UNIVERSITY AVE NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-6141
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Country | US
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Telephone | 763-755-1259
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Fax |
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Provider Business Mailing Address
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Address Line | 13136 QUAIL CREEK DR NE
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City | BLAINE
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State | MN
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Zip | 55449-6104
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Country | US
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Telephone | 763-862-3596
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Fax |
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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 | 117122
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License Number State | MN
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