Provider Demographics
NPI:1881635217
Name:BOOTHE, JEANNA SEWELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEANNA
Middle Name:SEWELL
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 SULLIVAN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1740
Mailing Address - Country:US
Mailing Address - Phone:256-461-6376
Mailing Address - Fax:256-461-6334
Practice Address - Street 1:3825 SULLIVAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1740
Practice Address - Country:US
Practice Address - Phone:256-461-6376
Practice Address - Fax:256-461-6334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12550OtherSTATE LICENSE NUMBER