MEDICARE: HERBERT L BURKE, INC

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	3336C0003X	Community/Retail Pharmacy	PH00659	NV

General Provider Information

NPI Number	:	1396842464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERBERT L BURKE, INC

Provider Business Mailing Address
First Line	:	5442 SUN VALLEY BLVD STE A
Second Line	:
City	:	SUN VALLEY
State	:	NV
Zip	:	89433-7657
Country	:	US
Telephone Number	:	775-673-5000
Fax Number	:	775-673-9365

Provider Business Practice Location Address
First Line	:	5442 SUN VALLEY BLVD STE A
Second Line	:
City	:	SUN VALLEY
State	:	NV
Zip	:	89433-7657
Country	:	US
Telephone Number	:	775-673-5000
Fax Number	:	775-673-9365

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HERBERT L BURKE
Credential	:	RPH
Telephone Number	:	775-673-5000

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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