Provider Demographics
NPI:1053962613
Name:BURTS PHARMACY MOORPARK
Entity type:Organization
Organization Name:BURTS PHARMACY MOORPARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LEARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-498-6675
Mailing Address - Street 1:865 PATRIOT DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:865 PATRIOT DR STE 103
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3407
Practice Address - Country:US
Practice Address - Phone:805-552-4500
Practice Address - Fax:805-552-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy