Provider Demographics
NPI:1558605816
Name:DAVIS-BURKETT FOOD CORP
Entity Type:Organization
Organization Name:DAVIS-BURKETT FOOD CORP
Other - Org Name:DAVIS FOOD AND DRUG #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-789-7011
Mailing Address - Street 1:495 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5124
Mailing Address - Country:US
Mailing Address - Phone:435-635-6944
Mailing Address - Fax:435-635-1547
Practice Address - Street 1:495 N STATE ST
Practice Address - Street 2:
Practice Address - City:LA VERKIN
Practice Address - State:UT
Practice Address - Zip Code:84745-5124
Practice Address - Country:US
Practice Address - Phone:435-635-6944
Practice Address - Fax:435-635-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8383904-1703333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy