Provider Demographics
NPI:1992849764
Name:JOHNNY H BURNS, T/A MARION DISCONT PHARMACY
Entity Type:Organization
Organization Name:JOHNNY H BURNS, T/A MARION DISCONT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PHARMACITS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-739-4400
Mailing Address - Street 1:134 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1956
Mailing Address - Country:US
Mailing Address - Phone:870-739-4400
Mailing Address - Fax:
Practice Address - Street 1:134 BLOCK ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1956
Practice Address - Country:US
Practice Address - Phone:870-739-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR093853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100627407Medicaid