Healthcare Provider Details

I. General information

NPI: 1326140229
Provider Name (Legal Business Name): PAUL BOOTH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL BOOTH RPH

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W CAPITOL AVE
WEST SACRAMENTO CA
95605-2624
US

IV. Provider business mailing address

9826 BLUE LAKE DR
FOLSOM CA
95630-1938
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-1755
  • Fax: 916-726-1065
Mailing address:
  • Phone: 916-834-0867
  • Fax: 916-726-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: