Provider Demographics
NPI:1932140712
Name:THE PHARMACY BOOTHE
Entity Type:Organization
Organization Name:THE PHARMACY BOOTHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:SEWELL
Authorized Official - Last Name:BOOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-461-6376
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL112348OtherSTATE LICENSE
AL515-19983OtherBCBS DME PROVIDER
0132009OtherNCPDP
0132009OtherNCPDP
BT8443347OtherDEA