MEDICARE: MS. MARY CATHERINE BURKETT RPH

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	183500000X	Pharmacist	PS29426	FL
2	183500000X	Pharmacist	RP-037946-L	PA

General Provider Information

NPI Number	:	1871835280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHERINE BURKETT RPH

Provider Business Mailing Address
First Line	:	2070 ENVOY CT
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-2560
Country	:	US
Telephone Number	:	727-709-4549
Fax Number	:	727-479-3047

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE
Second Line	:	SUITE 10
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-479-3048
Fax Number	:	727-479-3047

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

Provider Enumeration Date	:	03/23/2013
Last Update Date	:	03/23/2013

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