NPIMap

Organization Active NPI

Burke Community Pharmacy

  • Pharmacy
  • Burke, SD
National Provider Identifier
1710047949
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
100-1866 Issued in SD
Legal business name
BURKE COMMUNITY PHARMACY
Practice address
814 Jackson Street
Burke, SD 57523
Phone
(605) 775-2294
Fax
(605) 775-2564
NPI assigned
Dec 11, 2006
Last updated
Aug 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Renee C Sutton
Title
Pharmacist
Phone
(605) 775-2294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 100-1866 SD Primary

Addresses

Primary practice location

814 Jackson Street
Burke, SD 57523

Mailing address

814 Jackson Street
PO Box 358
Burke, SD 57523
Phone (605) 775-2294

Other identifiers 3

IdentifierTypeStateIssuer
4304488OtherSDNABP
8504200MedicaidSD
460219795-50MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930031855 SD DME Supplier - Pharmacy 1658581095 Practice locations: Burke, SD

National Provider Directory

National Provider Directory
Tax ID family
Burke Community Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1710047949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 JACKSON STREET",
            "address_2": "PO BOX 358",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "57523",
            "telephone_number": "605-775-2294",
            "fax_number": "605-775-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 JACKSON STREET",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "57523",
            "telephone_number": "605-775-2294",
            "fax_number": "605-775-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURKE COMMUNITY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "SUTTON",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "605-775-2294"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "SD",
            "license": "100-1866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4304488",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8504200",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460219795-50",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burke, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.