Healthcare Provider Details

I. General information

NPI: 1720200900
Provider Name (Legal Business Name): BOONE'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ULSTER STREET
BOYCE LA
71409
US

IV. Provider business mailing address

PO BOX 791 511 ULSTER STREET
BOYCE LA
71409
US

V. Phone/Fax

Practice location:
  • Phone: 318-793-2400
  • Fax: 318-793-9100
Mailing address:
  • Phone: 318-793-2400
  • Fax: 318-793-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number10751
License Number StateLA

VIII. Authorized Official

Name: DONALD RAY BOONE
Title or Position: PHARMACIST OWNER
Credential: DOCTOR OF PHARMACY
Phone: 318-793-2400