=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720866833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERONA SHELLIAN BURKE-JAMES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3428 BRUNER AVE APT 1
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10469-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-969-7561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3428 BRUNER AVE APT 1
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10469-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-969-7561
-----------------------------------------------------
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 | 30247490
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------