Provider Demographics
NPI:1821343369
Name:BOONE, JUSTIN LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
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 1:6718 BOXWOOD LN
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-1125
Mailing Address - Country:US
Mailing Address - Phone:513-532-3316
Mailing Address - Fax:
Practice Address - Street 1:151 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1015
Practice Address - Country:US
Practice Address - Phone:513-418-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist