Healthcare Provider Details

I. General information

NPI: 1003289034
Provider Name (Legal Business Name): BURLINGTON 8142 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 HARDEN ST
BURLINGTON NC
27215-7516
US

IV. Provider business mailing address

378 HARDEN ST
BURLINGTON NC
27215-7516
US

V. Phone/Fax

Practice location:
  • Phone: 336-222-9811
  • Fax: 336-222-9310
Mailing address:
  • Phone: 336-222-9811
  • Fax: 336-222-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12893
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT COCKMAN
Title or Position: OWNER
Credential:
Phone: 336-222-9811