Provider Demographics
NPI:1932335718
Name:BERKINTAYNE ENTERPRISES LLC
Entity Type:Organization
Organization Name:BERKINTAYNE ENTERPRISES LLC
Other - Org Name:CLEVELAND PHARMACY AND GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:706-878-0571
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-0030
Mailing Address - Country:US
Mailing Address - Phone:706-865-1212
Mailing Address - Fax:706-865-1221
Practice Address - Street 1:19 E JARRARD ST
Practice Address - Street 2:ON THE SQUARE
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1212
Practice Address - Country:US
Practice Address - Phone:706-865-1212
Practice Address - Fax:706-865-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1158864OtherNCPDP PROVIDER IDENTIFICATION NUMBER