Provider Demographics
NPI:1558390633
Name:BURNS RX LLC
Entity Type:Organization
Organization Name:BURNS RX LLC
Other - Org Name:PALACE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-625-3222
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-0007
Mailing Address - Country:US
Mailing Address - Phone:870-625-3222
Mailing Address - Fax:870-625-3216
Practice Address - Street 1:270 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-7466
Practice Address - Country:US
Practice Address - Phone:870-625-3222
Practice Address - Fax:870-625-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
ARAR202783336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600061501Medicaid
1989381OtherPK
AR160543407Medicaid
MO600061501Medicaid