Provider Demographics
NPI:1720479470
Name:B AND D PHARMACY MANAGEMENT
Entity Type:Organization
Organization Name:B AND D PHARMACY MANAGEMENT
Other - Org Name:BOONE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-295-4270
Mailing Address - Street 1:PO BOX 480999
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-0999
Mailing Address - Country:US
Mailing Address - Phone:334-295-4270
Mailing Address - Fax:334-295-0141
Practice Address - Street 1:2020 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2408
Practice Address - Country:US
Practice Address - Phone:334-280-4740
Practice Address - Fax:334-280-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1144543336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7404780001Medicare NSC