Healthcare Provider Details

I. General information

NPI: 1295627644
Provider Name (Legal Business Name): BURNSVILLE HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HIGHWAY 72
BURNSVILLE MS
38833-9103
US

IV. Provider business mailing address

600 HIGHWAY 365
TISHOMINGO MS
38873-9392
US

V. Phone/Fax

Practice location:
  • Phone: 662-279-9710
  • Fax:
Mailing address:
  • Phone: 662-279-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BOBO
Title or Position: OWNER
Credential: PHARMD
Phone: 662-279-9710