Provider Demographics
NPI:1619594660
Name:BURTS SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:BURTS SPECIALTY PHARMACY
Other - Org Name:BURT'S SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:562-522-4954
Mailing Address - Street 1:2628 CONEJO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1407
Mailing Address - Country:US
Mailing Address - Phone:805-375-0300
Mailing Address - Fax:805-375-0305
Practice Address - Street 1:2628 CONEJO CENTER DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1407
Practice Address - Country:US
Practice Address - Phone:805-375-0300
Practice Address - Fax:805-375-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy