Organization
BURTIS DRUG, INC.
Active
Other names
Gibson Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN AUSTIN BURTIS SR. PHA (OWNER)
(972) 579-0511
Entity
Organization
Contact information
Practice address
815 N O CONNOR RD, IRVING, TX 75061-4510
(972) 579-0511
(972) 579-0512
Mailing address
815 N O CONNOR RD, IRVING, TX 75061-4510
(972) 579-0511
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
11854
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4545565
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/31/2006
Last updated
06/13/2008
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