Organization
BOURBON DRUGS INC
Active
Other names
BOURBON DRUGS INC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BURNETT RPH (PIC)
(573) 732-4921
Entity
Organization
Contact information
Practice address
386 E PINE ST, BOURBON, MO 65441-7506
(573) 732-4921
(573) 732-3640
Mailing address
PO BOX 70, BOURBON, MO 65441-0070
(573) 732-4921
(573) 732-3640
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
005285
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2614926
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600247431
—
MO
Enumeration date
04/03/2007
Last updated
10/10/2011
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