Provider Demographics
NPI:1326140229
Name:BOOTH, PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:BOOTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:9826 BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1938
Mailing Address - Country:US
Mailing Address - Phone:916-834-0867
Mailing Address - Fax:916-726-1065
Practice Address - Street 1:500 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2624
Practice Address - Country:US
Practice Address - Phone:916-722-1755
Practice Address - Fax:916-726-1065
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist