# BURRELL PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leechburg Pharmacy Long Term Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356424709
- **Authorized official:** ALEXANDER J MICKLOW R.PH. (SECRETARY)
- **Authorized official phone:** (724) 845-1184

## Contact information

- **Practice address:** 111 2ND ST, LEECHBURG, PA 15656-1326
- **Practice address phone:** (724) 845-1184
- **Practice address fax:** (724) 842-2071
- **Mailing address:** 111 2ND ST, SUITE 200, LEECHBURG, PA 15656-1326
- **Mailing address phone:** (724) 845-1184
- **Mailing address fax:** (724) 842-2071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PP414776L | PA | Yes |

## Other

- **Enumeration date:** 10/21/2006
- **Last updated:** 05/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007627200003 | — | PA |
| 01 | — | 3967215 | NCPDP | PA |