Healthcare Provider Details

I. General information

NPI: 1083745541
Provider Name (Legal Business Name): BURNS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HWY 365 SOUTH
BURNSVILLE MS
38833-9320
US

IV. Provider business mailing address

PO BOX 315
BURNSVILLE MS
38833-0315
US

V. Phone/Fax

Practice location:
  • Phone: 662-427-0100
  • Fax: 662-427-0101
Mailing address:
  • Phone: 662-427-0100
  • Fax: 662-427-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-7806
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT TERRY DALTON JR.
Title or Position: PHARMACIST-IN-CHARGE
Credential: R.PH.
Phone: 662-427-0100