Provider Demographics
NPI:1730299793
Name:BURKE COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:BURKE COMMUNITY PHARMACY INC
Other - Org Name:WHITE RIVER COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-775-2294
Mailing Address - Street 1:309 EAST 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:SD
Mailing Address - Zip Code:57579
Mailing Address - Country:US
Mailing Address - Phone:605-259-3102
Mailing Address - Fax:605-259-3562
Practice Address - Street 1:309 EAST 4TH ST.
Practice Address - Street 2:
Practice Address - City:WHITE RIVER
Practice Address - State:SD
Practice Address - Zip Code:57579
Practice Address - Country:US
Practice Address - Phone:605-259-3102
Practice Address - Fax:605-259-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SD100-20523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176201OtherPK
SD4302460OtherNABP #
SD1199040001Medicare ID - Type Unspecified