Provider Demographics
NPI:1598235996
Name:BURGESS DRUG STORE INC
Entity Type:Organization
Organization Name:BURGESS DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-376-5043
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653
Mailing Address - Country:US
Mailing Address - Phone:606-376-9662
Mailing Address - Fax:606-376-9658
Practice Address - Street 1:2157 S. HWY 27
Practice Address - Street 2:STE # 2
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647
Practice Address - Country:US
Practice Address - Phone:606-376-9662
Practice Address - Fax:606-376-9658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURGESS DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy