Healthcare Provider Details

I. General information

NPI: 1972956357
Provider Name (Legal Business Name): BOONE AND DAVIS PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S JACKSON ST
GROVE HILL AL
36451-3007
US

IV. Provider business mailing address

PO BOX 480999
LINDEN AL
36748-0999
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3669
  • Fax: 251-275-8190
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 Number114644
License Number StateAL

VIII. Authorized Official

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