Provider Demographics
NPI:1770655904
Name:BOONE PHARMACY MANAGEMENT INC
Entity type:Organization
Organization Name:BOONE PHARMACY MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-341-3466
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-0426
Mailing Address - Country:US
Mailing Address - Phone:251-246-2271
Mailing Address - Fax:251-246-2277
Practice Address - Street 1:201 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2717
Practice Address - Country:US
Practice Address - Phone:251-246-2271
Practice Address - Fax:251-246-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1064403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-07741OtherNABP
AL13-01196OtherALABAMA SALES TAX #
AL100001841Medicaid
AL01-07741OtherNABP
AL01-07741OtherNABP