Provider Demographics
NPI:1417215856
Name:BOATRIGHT, JIMMY MACK (RPH)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:MACK
Last Name:BOATRIGHT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PERRY LANE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-9739
Mailing Address - Country:US
Mailing Address - Phone:912-264-2561
Mailing Address - Fax:
Practice Address - Street 1:1600 PERRY LANE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-9739
Practice Address - Country:US
Practice Address - Phone:912-264-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist