MEDICARE: BURNHAM MCKINNEY PHARMACIES INC

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	251F00000X	Home Infusion Agency	00774/01.1	MS
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	00774/01.1	MS
3	332BX2000X	Oxygen Equipment & Supplies (DME)	00774/01.1	MS
4	333600000X	Pharmacy	00774/01.1	MS
5	3336C0003X	Community/Retail Pharmacy	00774011	MS
6	3336C0004X	Compounding Pharmacy	00774011	MS
7	3336H0001X	Home Infusion Therapy Pharmacy	00774011	MS
8	332B00000X	Durable Medical Equipment & Medical Supplies	00774/01.1	MS

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770589095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNHAM MCKINNEY PHARMACIES INC

Provider Business Mailing Address
First Line	:	PO BOX 8647
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-0010
Country	:	US
Telephone Number	:	228-475-3411
Fax Number	:	228-475-9251

Provider Business Practice Location Address
First Line	:	5001 MAIN ST
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39563-2738
Country	:	US
Telephone Number	:	228-475-3411
Fax Number	:	228-475-9251

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JOHN A MCKINNEY
Credential	:	RPH
Telephone Number	:	228-475-3411

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/24/2008

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