Healthcare Provider Details

I. General information

NPI: 1538981063
Provider Name (Legal Business Name): BOONE PHARMACY MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 US HIGHWAY 80 E
DEMOPOLIS AL
36732-3619
US

IV. Provider business mailing address

PO BOX 480999
LINDEN AL
36748-0999
US

V. Phone/Fax

Practice location:
  • Phone: 334-295-4270
  • Fax: 334-295-0141
Mailing address:
  • Phone: 334-295-4270
  • Fax: 334-295-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD LAMAR BOONE
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 334-341-3466