Healthcare Provider Details

I. General information

NPI: 1558755033
Provider Name (Legal Business Name): BENJAMIN BURKART PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COMMERCIAL ST SE
HANCEVILLE AL
35077-5516
US

IV. Provider business mailing address

101 COMMERCIAL ST SE
HANCEVILLE AL
35077-5516
US

V. Phone/Fax

Practice location:
  • Phone: 256-352-4110
  • Fax: 256-352-5660
Mailing address:
  • Phone: 256-352-4110
  • Fax: 256-352-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS10718
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19305
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: