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General NPI Number Information
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NPI Number | 1891594495
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Entity Type | Individual
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Provider Name | JASON BURK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 2 COTTONWOOD RD
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City | GLEN CARBON
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State | IL
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Zip | 62034-2782
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Country | US
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Telephone | 618-288-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 521B WOOD THRUSH ST
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City | TROY
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State | IL
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Zip | 62294-2144
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Country | US
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Telephone |
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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 | 051306864
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License Number State | IL
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