Provider Demographics
NPI:1073558250
Name:BURKLOW PHARMACY INC
Entity Type:Organization
Organization Name:BURKLOW PHARMACY INC
Other - Org Name:BURKLOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-293-1011
Mailing Address - Street 1:4880 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8762
Mailing Address - Country:US
Mailing Address - Phone:850-995-9999
Mailing Address - Fax:850-995-0095
Practice Address - Street 1:4880 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8762
Practice Address - Country:US
Practice Address - Phone:850-995-9999
Practice Address - Fax:850-995-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH157613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2010633OtherPK
FL106315400Medicaid
1080477OtherNCPDP PROVIDER IDENTIFICATION NUMBER