Provider Demographics
NPI:1619269016
Name:BURKE PHARMACY
Entity Type:Organization
Organization Name:BURKE PHARMACY
Other - Org Name:BURKE PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:TRUMAN
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-437-5800
Mailing Address - Street 1:301 W MEETING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3866
Mailing Address - Country:US
Mailing Address - Phone:828-437-5800
Mailing Address - Fax:828-438-8755
Practice Address - Street 1:301 W MEETING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3866
Practice Address - Country:US
Practice Address - Phone:828-437-5800
Practice Address - Fax:828-438-8755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURKE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies