MEDICARE: DR. FAROOQ DAVID BURHAM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS62665	FL

General Provider Information

NPI Number	:	1073608949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAROOQ DAVID BURHAM PHARMD

Provider Business Mailing Address
First Line	:	178 GRAND PALM CT
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-0005
Country	:	US
Telephone Number	:	301-795-8732
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 MASSEY AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32228
Country	:	US
Telephone Number	:	904-270-4280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/18/2026

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