Provider Demographics
NPI:1649474859
Name:BURNSVILLE PHARMACY INC
Entity type:Organization
Organization Name:BURNSVILLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:828-682-9901
Mailing Address - Street 1:310 WEST BYPASS HWY 19E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714
Mailing Address - Country:US
Mailing Address - Phone:828-682-9901
Mailing Address - Fax:828-682-9930
Practice Address - Street 1:310 WEST BYPASS HWY 19E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714
Practice Address - Country:US
Practice Address - Phone:828-682-9901
Practice Address - Fax:828-682-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC083943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy