Provider Demographics
NPI:1518037985
Name:BOUGHTON, BILLY BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:BRUCE
Last Name:BOUGHTON
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 1:2819 N FITZHUGH AVE
Mailing Address - Street 2:#2302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3144
Mailing Address - Country:US
Mailing Address - Phone:214-728-4545
Mailing Address - Fax:
Practice Address - Street 1:3535 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2006
Practice Address - Country:US
Practice Address - Phone:214-370-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346611835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology