Provider Demographics
NPI:1437213261
Name:JL BURCH,LLC
Entity Type:Organization
Organization Name:JL BURCH,LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-386-7004
Mailing Address - Street 1:101 MERCHANTS SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-2258
Mailing Address - Country:US
Mailing Address - Phone:770-386-7004
Mailing Address - Fax:770-386-7523
Practice Address - Street 1:101 MERCHANTS SQUARE DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-2258
Practice Address - Country:US
Practice Address - Phone:770-386-7004
Practice Address - Fax:770-386-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0084313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00878512AMedicaid
GA1147582OtherNCPDP
GA1147582OtherNCPDP
GA1147582OtherNCPDP