Provider Demographics
NPI:1245062405
Name:BURNHAM DRUGS NO. 4 LLC
Entity type:Organization
Organization Name:BURNHAM DRUGS NO. 4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-475-3411
Mailing Address - Street 1:PO BOX 8647
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-0010
Mailing Address - Country:US
Mailing Address - Phone:228-475-3411
Mailing Address - Fax:
Practice Address - Street 1:12500 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-9614
Practice Address - Country:US
Practice Address - Phone:228-826-2156
Practice Address - Fax:228-826-2156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURNHAM DRUGS NO. 4 MOT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy