Provider Demographics
NPI:1467079186
Name:BOONE, JOHNATHAN DALLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:DALLAS
Last Name:BOONE
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 1:202 UNIVERSITY PKWY APT 28E
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7355
Mailing Address - Country:US
Mailing Address - Phone:828-674-3686
Mailing Address - Fax:
Practice Address - Street 1:1402 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4279
Practice Address - Country:US
Practice Address - Phone:423-588-5099
Practice Address - Fax:423-588-5935
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist