Provider Demographics
NPI:1285962720
Name:BURTON PHARMACY INC
Entity type:Organization
Organization Name:BURTON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-210-1291
Mailing Address - Street 1:3375 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529
Mailing Address - Country:US
Mailing Address - Phone:810-742-9005
Mailing Address - Fax:810-742-9007
Practice Address - Street 1:3375 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529
Practice Address - Country:US
Practice Address - Phone:810-742-9005
Practice Address - Fax:810-742-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010092433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373380OtherNCPDP PROVIDER IDENTIFICATION NUMBER