Provider Demographics
NPI:1497809156
Name:BURNS INC
Entity Type:Organization
Organization Name:BURNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-423-3628
Mailing Address - Street 1:1519 W QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-1132
Mailing Address - Country:US
Mailing Address - Phone:662-423-3628
Mailing Address - Fax:662-423-3620
Practice Address - Street 1:1519 W QUITMAN ST
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1132
Practice Address - Country:US
Practice Address - Phone:662-423-3628
Practice Address - Fax:662-423-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS002073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00034070Medicaid
MS00034070Medicaid