Healthcare Provider Details

I. General information

NPI: 1598235996
Provider Name (Legal Business Name): BURGESS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 S. HWY 27 STE # 2
STEARNS KY
42647
US

IV. Provider business mailing address

PO BOX 279
WHITLEY CITY KY
42653
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-9662
  • Fax: 606-376-9658
Mailing address:
  • Phone: 606-376-9662
  • Fax: 606-376-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAT WATSON
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 606-376-5043