Healthcare Provider Details

I. General information

NPI: 1205940277
Provider Name (Legal Business Name): BURKE APOTHECARY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DOGWOOD DR
WAYNESBORO GA
30830-5445
US

IV. Provider business mailing address

PO BOX 666
WAYNESBORO GA
30830-0666
US

V. Phone/Fax

Practice location:
  • Phone: 706-554-5133
  • Fax: 706-554-0941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE006816
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WALTER SEEGER
Title or Position: PRES OWNER
Credential: RPH
Phone: 706-554-5133