MEDICARE: BURNS RX 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	AR20278	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1989381	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558390633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNS RX LLC

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-0007
Country	:	US
Telephone Number	:	870-625-3222
Fax Number	:	870-625-3216

Provider Business Practice Location Address
First Line	:	270 MAIN ST
Second Line	:
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7466
Country	:	US
Telephone Number	:	870-625-3222
Fax Number	:	870-625-3216

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	SARAH CLARK
Credential	:
Telephone Number	:	870-625-3222

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/16/2024

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Directions to “BURNS RX LLC ” Practice Location

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