Provider Demographics
NPI:1780287904
Name:BOONES PHARMACY INC
Entity type:Organization
Organization Name:BOONES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-289-8989
Mailing Address - Street 1:951 US HIGHWAY 80 W # B
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4156
Mailing Address - Country:US
Mailing Address - Phone:334-289-8989
Mailing Address - Fax:
Practice Address - Street 1:203 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:36732-3673
Practice Address - Country:US
Practice Address - Phone:334-341-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONES PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy