Provider Demographics
NPI:1265608657
Name:BOONE, JEFFREY D (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:BOONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3737
Mailing Address - Country:US
Mailing Address - Phone:231-777-4969
Mailing Address - Fax:231-767-0930
Practice Address - Street 1:821 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3737
Practice Address - Country:US
Practice Address - Phone:231-777-4969
Practice Address - Fax:231-767-0930
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist