Provider Demographics
NPI:1770574519
Name:BURCH DISCOUNT DRUGS INC
Entity type:Organization
Organization Name:BURCH DISCOUNT DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-482-3330
Mailing Address - Street 1:110 NORTH PECAN STREET
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-1457
Mailing Address - Country:US
Mailing Address - Phone:229-482-3330
Mailing Address - Fax:
Practice Address - Street 1:110 NORTH PECAN STREET
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-1457
Practice Address - Country:US
Practice Address - Phone:229-482-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006614333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00320273AMedicaid
GA0236700001Medicare ID - Type Unspecified