Organization
WILLIAM BURKE LTD
Active
Other names
MAIN AT LOCUST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW PLOEHN (OWNER)
(563) 324-5004
Entity
Organization
Contact information
Practice address
129 WEST LOCUST, DAVENPORT, IA 52803
(563) 324-1641
(563) 324-3005
Mailing address
2151 KIMBERLY RD, BETTENDORF, IA 52722-3628
(563) 324-5004
(563) 324-3305
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IA
3336C0002X
Clinic Pharmacy
16D0922143
IA
3336C0003X
Community/Retail Pharmacy
Primary
774
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069195
—
IA
05
—
0233577
—
IA
01
—
59654
BLUE CROSS BLUE SHIELD
IA
Enumeration date
01/02/2007
Last updated
02/23/2024
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