Provider Demographics
NPI:1356775597
Name:BOOZER, GARY R (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:BOOZER
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 1:4905 N ROAD 68
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8934
Mailing Address - Country:US
Mailing Address - Phone:509-545-4884
Mailing Address - Fax:509-545-4334
Practice Address - Street 1:4905 N ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8934
Practice Address - Country:US
Practice Address - Phone:509-545-4884
Practice Address - Fax:509-545-4334
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist