Provider Demographics
NPI:1295026508
Name:BOONE, KLYDA LEAH (RPH)
Entity Type:Individual
Prefix:
First Name:KLYDA
Middle Name:LEAH
Last Name:BOONE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0849
Mailing Address - Country:US
Mailing Address - Phone:336-846-2673
Mailing Address - Fax:
Practice Address - Street 1:2 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-7375
Practice Address - Country:US
Practice Address - Phone:336-246-2790
Practice Address - Fax:336-246-2023
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist