Healthcare Provider Details

I. General information

NPI: 1932140712
Provider Name (Legal Business Name): THE PHARMACY BOOTHE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 SULLIVAN ST SUITE 2
MADISON AL
35758-1740
US

IV. Provider business mailing address

3825 SULLIVAN ST SUITE 2
MADISON AL
35758-1740
US

V. Phone/Fax

Practice location:
  • Phone: 256-461-6376
  • Fax: 256-461-6334
Mailing address:
  • Phone: 256-461-6376
  • Fax: 256-461-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112348
License Number StateAL

VIII. Authorized Official

Name: DR. JEANNA SEWELL BOOTHE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 256-461-6376