Healthcare Provider Details

I. General information

NPI: 1710047949
Provider Name (Legal Business Name): BURKE COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 JACKSON STREET
BURKE SD
57523
US

IV. Provider business mailing address

814 JACKSON STREET PO BOX 358
BURKE SD
57523
US

V. Phone/Fax

Practice location:
  • Phone: 605-775-2294
  • Fax: 605-775-2564
Mailing address:
  • Phone: 605-775-2294
  • Fax: 605-775-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number100-1866
License Number StateSD

VIII. Authorized Official

Name: RENEE C SUTTON
Title or Position: PHARMACIST
Credential:
Phone: 605-775-2294