=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770589095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURNHAM MCKINNEY PHARMACIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5001 MAIN ST
-----------------------------------------------------
City | MOSS POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39563-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-475-3411
-----------------------------------------------------
Fax | 228-475-9251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8647
-----------------------------------------------------
City | MOSS POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39562-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-475-3411
-----------------------------------------------------
Fax | 228-475-9251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. JOHN A MCKINNEY
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 228-475-3411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | 00774/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 00774/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 00774/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 00774/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 00774011
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number | 00774011
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number | 00774011
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 00774/01.1
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------