Provider Demographics
NPI:1134919988
Name:MAIN FORK PHARMACY
Entity type:Organization
Organization Name:MAIN FORK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-566-6801
Mailing Address - Street 1:41841 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:CA
Mailing Address - Zip Code:93271-9795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41841 SIERRA DR
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:CA
Practice Address - Zip Code:93271-9795
Practice Address - Country:US
Practice Address - Phone:559-566-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy