Healthcare Provider Details

I. General information

NPI: 1194839183
Provider Name (Legal Business Name): BOONES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 S MAIN ST
POPLARVILLE MS
39470-3111
US

IV. Provider business mailing address

937 S MAIN ST
POPLARVILLE MS
39470-3111
US

V. Phone/Fax

Practice location:
  • Phone: 601-795-4566
  • Fax: 601-795-4571
Mailing address:
  • Phone: 601-795-4566
  • Fax: 601-795-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00935/1.1
License Number StateMS

VIII. Authorized Official

Name: LARRY BOONE
Title or Position: PRES
Credential:
Phone: 601-795-4566