Provider Demographics
NPI:1205389152
Name:BOU, BOONE NAVATH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BOONE
Middle Name:NAVATH
Last Name:BOU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3401
Mailing Address - Country:US
Mailing Address - Phone:323-569-1932
Mailing Address - Fax:323-569-1972
Practice Address - Street 1:4621 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3401
Practice Address - Country:US
Practice Address - Phone:323-569-1932
Practice Address - Fax:323-569-1972
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist