Provider Demographics
NPI:1861500118
Name:EAST BURKE PHARMACY INC.
Entity type:Organization
Organization Name:EAST BURKE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-397-3420
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:300 MAIN AVE WEST
Mailing Address - City:HILDEBRAN
Mailing Address - State:NC
Mailing Address - Zip Code:28637-0664
Mailing Address - Country:US
Mailing Address - Phone:828-397-3420
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN AVE WEST
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637
Practice Address - Country:US
Practice Address - Phone:828-397-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7730333600000X, 3336C0003X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0125542Medicaid
NC3438618OtherNCPDP
NC4191560002Medicare ID - Type Unspecified