MEDICARE: JL BURCH,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHRE008431	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1147582	OTHER	GA	NCPDP

General Provider Information

NPI Number	:	1437213261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JL BURCH,LLC

Provider Business Mailing Address
First Line	:	101 MERCHANTS SQUARE DR
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-2258
Country	:	US
Telephone Number	:	770-386-7004
Fax Number	:	770-386-7523

Provider Business Practice Location Address
First Line	:	101 MERCHANTS SQUARE DR
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-2258
Country	:	US
Telephone Number	:	770-386-7004
Fax Number	:	770-386-7523

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. JACK LEE BURCH
Credential	:	R.PH.
Telephone Number	:	770-386-7004

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	03/07/2023

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Directions to “JL BURCH,LLC ” Practice Location

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