Provider Demographics
NPI:1841253523
Name:BURKE PHARMACY INC
Entity type:Organization
Organization Name:BURKE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:TECH/DME
Authorized Official - Phone:828-437-8025
Mailing Address - Street 1:301 W MEETING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3866
Mailing Address - Country:US
Mailing Address - Phone:828-437-8025
Mailing Address - Fax:828-438-8755
Practice Address - Street 1:301 W MEETING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3866
Practice Address - Country:US
Practice Address - Phone:828-437-8025
Practice Address - Fax:828-438-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5037332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700344Medicaid
NC0157930001Medicare NSC