Healthcare Provider Details

I. General information

NPI: 1053618694
Provider Name (Legal Business Name): EAST BURKE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN AVE WEST
HILDEBRAN NC
28637-0664
US

IV. Provider business mailing address

PO BOX 664
HILDEBRAN NC
28637-0664
US

V. Phone/Fax

Practice location:
  • Phone: 828-397-3420
  • Fax: 828-397-3420
Mailing address:
  • Phone: 828-397-3420
  • Fax: 828-397-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID HOYLE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 828-397-3420