Provider Demographics
NPI:1326059817
Name:BURRYS PHARMACY, INC.
Entity Type:Organization
Organization Name:BURRYS PHARMACY, INC.
Other - Org Name:BURRYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-787-3787
Mailing Address - Street 1:500 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5019
Mailing Address - Country:US
Mailing Address - Phone:352-787-3787
Mailing Address - Fax:352-787-6926
Practice Address - Street 1:500 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5019
Practice Address - Country:US
Practice Address - Phone:352-787-3787
Practice Address - Fax:352-787-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH6923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005110OtherPK
FL025392800Medicaid