Provider Demographics
NPI:1679193130
Name:BOOBIL, LLC
Entity Type:Organization
Organization Name:BOOBIL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:WANDA
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-282-3072
Mailing Address - Street 1:6460 HWY 84
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:GA
Mailing Address - Zip Code:31557-5016
Mailing Address - Country:US
Mailing Address - Phone:912-647-0777
Mailing Address - Fax:
Practice Address - Street 1:6460 HWY 84
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:GA
Practice Address - Zip Code:31557-5016
Practice Address - Country:US
Practice Address - Phone:912-647-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy