Healthcare Provider Details

I. General information

NPI: 1558390633
Provider Name (Legal Business Name): BURNS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MAIN ST
MAMMOTH SPRING AR
72554-7466
US

IV. Provider business mailing address

PO BOX 7
MAMMOTH SPRING AR
72554-0007
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3222
  • Fax: 870-625-3216
Mailing address:
  • Phone: 870-625-3222
  • Fax: 870-625-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20278
License Number StateAR

VIII. Authorized Official

Name: SARAH CLARK
Title or Position: MEMBER/OWNER
Credential:
Phone: 870-625-3222