Provider Demographics
NPI:1225370877
Name:BURNHAM-MCKINNEY PHARMACY NO 6 LLC
Entity Type:Organization
Organization Name:BURNHAM-MCKINNEY PHARMACY NO 6 LLC
Other - Org Name:BURNHAM DRUGS #6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-475-3411
Mailing Address - Street 1:PO BOX 8647
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-0010
Mailing Address - Country:US
Mailing Address - Phone:228-475-3411
Mailing Address - Fax:228-471-1400
Practice Address - Street 1:12114 OLD HWY 63 S
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-6626
Practice Address - Country:US
Practice Address - Phone:228-475-3411
Practice Address - Fax:228-471-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS12179113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139497OtherPK