Healthcare Provider Details

I. General information

NPI: 1043375710
Provider Name (Legal Business Name): BURWELL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 GRAND AVE
BURWELL NE
68823-4153
US

IV. Provider business mailing address

PO BOX 520
BURWELL NE
68823
US

V. Phone/Fax

Practice location:
  • Phone: 308-346-4747
  • Fax: 308-346-4869
Mailing address:
  • Phone: 308-346-4747
  • Fax: 308-346-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number863
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONALD SNYDER
Title or Position: PIC
Credential: BS
Phone: 308-346-4747