Provider Demographics
NPI:1548999436
Name:FUNDERBURKS PHARMACY INC
Entity type:Organization
Organization Name:FUNDERBURKS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUDDUTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-429-5337
Mailing Address - Street 1:134 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2240
Mailing Address - Country:US
Mailing Address - Phone:901-487-0848
Mailing Address - Fax:
Practice Address - Street 1:4962 HIGHWAY 305 STE B
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-5821
Practice Address - Country:US
Practice Address - Phone:901-487-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNDERBURKS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy