Provider Demographics
NPI:1114435583
Name:BURT'S PHARMACY, INC
Entity Type:Organization
Organization Name:BURT'S PHARMACY, INC
Other - Org Name:BURT'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-498-6675
Mailing Address - Street 1:2333 BORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3206
Mailing Address - Country:US
Mailing Address - Phone:805-498-6675
Mailing Address - Fax:
Practice Address - Street 1:2900 TOWNSGATE RD STE 105
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5818
Practice Address - Country:US
Practice Address - Phone:805-371-4000
Practice Address - Fax:805-374-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy