Provider Demographics
NPI:1083745541
Name:BURNS INC
Entity Type:Organization
Organization Name:BURNS INC
Other - Org Name:BURNSVILLE DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-427-0100
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38833-0315
Mailing Address - Country:US
Mailing Address - Phone:662-427-0100
Mailing Address - Fax:662-427-0101
Practice Address - Street 1:603 HWY 365 SOUTH
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38833-9320
Practice Address - Country:US
Practice Address - Phone:662-427-0100
Practice Address - Fax:662-427-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-7806183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02759897Medicaid