Provider Demographics
NPI:1851620066
Name:WILLIAM BURKE LTD
Entity Type:Organization
Organization Name:WILLIAM BURKE LTD
Other - Org Name:MAIN AT LOCUST PHARMACY AND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-324-5004
Mailing Address - Street 1:2151 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-324-1641
Mailing Address - Fax:563-884-4480
Practice Address - Street 1:129 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2803
Practice Address - Country:US
Practice Address - Phone:563-324-5004
Practice Address - Fax:563-324-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16D09221433336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1663Medicare PIN