Organization
BURGIE DRUG STORE LLC
Active
Other names
BURGIE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY PROFFITT DPH (OWNER)
(423) 542-4622
Entity
Organization
Contact information
Practice address
1000 W G ST, ELIZABETHTON, TN 37643-2959
(423) 542-4622
(423) 542-2564
Mailing address
1000 W G ST, ELIZABETHTON, TN 37643-2959
(423) 542-4622
(423) 542-2564
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
348
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094801
PK
—
Enumeration date
08/10/2006
Last updated
08/16/2019
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