MEDICARE: BURNSRX.LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	AR20278	AR

General Provider Information

NPI Number	:	1770963563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNSRX.LLC

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 MAIN ST
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7466
Country	:	US
Telephone Number	:	870-625-3222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA N BURNS
Credential	:	PHARMD
Telephone Number	:	870-625-3222

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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