Provider Demographics
NPI:1710047949
Name:BURKE COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:BURKE COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-775-2294
Mailing Address - Street 1:814 JACKSON STREET
Mailing Address - Street 2:PO BOX 358
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523
Mailing Address - Country:US
Mailing Address - Phone:605-775-2294
Mailing Address - Fax:605-775-2564
Practice Address - Street 1:814 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523
Practice Address - Country:US
Practice Address - Phone:605-775-2294
Practice Address - Fax:605-775-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-1866333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4304488OtherNABP
SD8504200Medicaid
NE460219795-50Medicaid
SD5365510001Medicare NSC