Organization
P. ROMAN BURK DPM PC
Active
Parent organization
P. ROMAN BURK DPM PC
Other names
Mountain Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
P. ROMAN BURK DPM PC
Authorized official
P. ROMAN BURK DPM (OWNER)
(208) 855-0701
Entity
Organization
Contact information
Practice address
4605 ENTERPRISE WAY, STE: 102, CALDWELL, ID 83605
(208) 795-5090
Mailing address
2667 E GALA CT STE 125, MERIDIAN, ID 83642-2789
(208) 795-5090
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Enumeration date
09/16/2022
Last updated
09/16/2022
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