Provider Demographics
NPI:1003991977
Name:BURNHAM-MCKINNEY PHARMACIES, INC. #2
Entity Type:Organization
Organization Name:BURNHAM-MCKINNEY PHARMACIES, INC. #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-475-3411
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:ESCATAWPA
Mailing Address - State:MS
Mailing Address - Zip Code:39552-0722
Mailing Address - Country:US
Mailing Address - Phone:228-475-3909
Mailing Address - Fax:228-475-3903
Practice Address - Street 1:7709 HIGHWAY 613
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562
Practice Address - Country:US
Practice Address - Phone:228-475-3909
Practice Address - Fax:228-475-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0030108Medicaid