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General NPI Number Information
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NPI Number | 1295627644
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Entity Type | Organization
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Legal Business Name | BURNSVILLE HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 301 HIGHWAY 72
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City | BURNSVILLE
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State | MS
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Zip | 38833-9103
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Country | US
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Telephone | 662-279-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 600 HIGHWAY 365
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City | TISHOMINGO
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State | MS
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Zip | 38873-9392
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Country | US
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Telephone | 662-279-9710
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN BOBO
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Credential | PHARMD
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Telephone | 662-279-9710
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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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