Healthcare Provider Details

I. General information

NPI: 1730299793
Provider Name (Legal Business Name): BURKE COMMUNITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 EAST 4TH ST.
WHITE RIVER SD
57579
US

IV. Provider business mailing address

309 EAST 4TH ST.
WHITE RIVER SD
57579
US

V. Phone/Fax

Practice location:
  • Phone: 605-259-3102
  • Fax: 605-259-3562
Mailing address:
  • Phone: 605-259-3102
  • Fax: 605-259-3562

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 Number100-2052
License Number StateSD

VIII. Authorized Official

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