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General NPI Number Information
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NPI Number | 1437213261
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Entity Type | Organization
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Legal Business Name | JL BURCH,LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 101 MERCHANTS SQUARE DR
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2258
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Country | US
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Telephone | 770-386-7004
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Fax | 770-386-7523
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Provider Business Mailing Address
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Address Line | 101 MERCHANTS SQUARE DR
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2258
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Country | US
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Telephone | 770-386-7004
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Fax | 770-386-7523
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JACK LEE BURCH
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Credential | R.PH.
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Telephone | 770-386-7004
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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 | PHRE008431
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License Number State | GA
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