Healthcare Provider Details

I. General information

NPI: 1427181080
Provider Name (Legal Business Name): BURNS DRUGSTORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W COMMERCIAL ST
OZARK AR
72949-3113
US

IV. Provider business mailing address

615 W COMMERCIAL ST
OZARK AR
72949-3113
US

V. Phone/Fax

Practice location:
  • Phone: 479-667-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberAR14057
License Number StateAR

VIII. Authorized Official

Name: DONALD W BURNS
Title or Position: OWNER
Credential:
Phone: 479-667-3131