Provider Demographics
NPI:1053618694
Name:EAST BURKE PHARMACY
Entity type:Organization
Organization Name:EAST BURKE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-397-3420
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
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:828-397-3477
Practice Address - Street 1:300 MAIN AVE WEST
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637-0664
Practice Address - Country:US
Practice Address - Phone:828-397-3420
Practice Address - Fax:828-397-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0125542Medicaid
4191560002OtherMEDICARE PTAN