Healthcare Provider Details

I. General information

NPI: 1598806309
Provider Name (Legal Business Name): RICHARD LAMAR BOONE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S. MAIN ST.
LINDEN AL
36748
US

IV. Provider business mailing address

310 SOUTH MAIN STREET POST OFFICE BOX 480999
LINDEN AL
36748
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 Code183500000X
TaxonomyPharmacist
License Number12000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: