1770589095 NPI number — BURNHAM MCKINNEY PHARMACIES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770589095 NPI number — BURNHAM MCKINNEY PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURNHAM MCKINNEY PHARMACIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770589095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSS POINT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39563-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-475-3411
Provider Business Practice Location Address Fax Number:
228-475-9251
Provider Enumeration Date:
06/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
228-475-3411

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  00774/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 00774/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 00774/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 00774/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 00774/01.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 00774011 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X , with the licence number: 00774011 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 00774011 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100340002 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440057 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".