Burgess Drug Store Inc
Organization Active NPI Community/Retail Pharmacy · Whitley City, KY
NPI 1043350069 · NPPES record last updated Sep 13, 2007
Key facts
- NPI
- 1043350069
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1244 (KY)
- Legal business name
- BURGESS DRUG STORE INC
- Practice address
- 19 Medical Loop
Whitley City, KY 42653-0309 - Phone
- (606) 376-5043
- Fax
- (606) 376-5466
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- James Ball, RPH
- Title
- Owner
- Phone
- (606) 376-5043
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930014702 | KY | DME Supplier - Pharmacy | 0345369062 | Practice locations: Whitley City, KY |
National Provider Directory
- Tax ID family
- Burgess Drug Store Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1244 | KY | Yes |
Addresses
Primary practice location
19 Medical Loop
Whitley City, KY 42653-0309
Mailing address
PO Box 309
Whitley City, KY 42653-0309
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54014733 | Medicaid | KY | |
| 1809764 | Other | OTHER ID NUMBER |
Other names
- BURGESS DRUGS
Other providers in Whitley City, KY
- Bluegrass Oxygen Inc
- Bowynn Inc
- Kimberly Margarett Brumley
- Mark Anthony Bryant
- Buckeye Home Health Center, Inc.
- Burgess Drug Store Inc
- Jerald Miller Burgess
- Butterfly Behavior Therapy Group LLC
- Jennifer Casey
- Stephanie Cash-Smith
All providers in Whitley City, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.