Healthcare Provider Details

I. General information

NPI: 1861500118
Provider Name (Legal Business Name): EAST BURKE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN AVE WEST
HILDEBRAN NC
28637
US

IV. Provider business mailing address

PO BOX 664 300 MAIN AVE WEST
HILDEBRAN NC
28637-0664
US

V. Phone/Fax

Practice location:
  • Phone: 828-397-3420
  • Fax:
Mailing address:
  • Phone: 828-397-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7730
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7730
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number7730
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7730
License Number StateNC

VIII. Authorized Official

Name: MRS. LEIGH ANNE ABERNATHY
Title or Position: PHARMACIST
Credential:
Phone: 828-397-3420