Provider Demographics
NPI:1619269792
Name:BOONE, MARCUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
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 1:13000 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7652
Mailing Address - Country:US
Mailing Address - Phone:704-295-0849
Mailing Address - Fax:704-295-0854
Practice Address - Street 1:13000 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7652
Practice Address - Country:US
Practice Address - Phone:704-295-0849
Practice Address - Fax:704-295-0854
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist