Healthcare Provider Details

I. General information

NPI: 1558517508
Provider Name (Legal Business Name): BURKLOW DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 INTERNATIONAL DR STE F
MOBILE AL
36606-3020
US

IV. Provider business mailing address

3207 INTERNATIONAL DR STE F
MOBILE AL
36606-3020
US

V. Phone/Fax

Practice location:
  • Phone: 251-478-0758
  • Fax: 877-729-1015
Mailing address:
  • Phone: 251-478-0758
  • Fax: 877-729-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number192883
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CHANDLER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 251-478-0758