Provider Demographics
NPI:1164960688
Name:ANDERSON BURRIS INC
Entity Type:Organization
Organization Name:ANDERSON BURRIS INC
Other - Org Name:HOPE WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-546-2502
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-0366
Mailing Address - Country:US
Mailing Address - Phone:812-546-2502
Mailing Address - Fax:812-546-2336
Practice Address - Street 1:645 HARRISON ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:IN
Practice Address - Zip Code:47246-1203
Practice Address - Country:US
Practice Address - Phone:812-287-8884
Practice Address - Fax:812-287-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IN60006601A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167643OtherPK
IN300002470AMedicaid