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General NPI Number Information
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NPI Number | 1205940277
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Entity Type | Organization
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Legal Business Name | BURKE APOTHECARY INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 201 DOGWOOD DR
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City | WAYNESBORO
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State | GA
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Zip | 30830-5445
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Country | US
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Telephone | 706-554-5133
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Fax | 706-554-0941
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Provider Business Mailing Address
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Address Line | PO BOX 666
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City | WAYNESBORO
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State | GA
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Zip | 30830-0666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES OWNER
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Name | WALTER SEEGER
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Credential | RPH
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Telephone | 706-554-5133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE006816
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License Number State | GA
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