Healthcare Provider Details

I. General information

NPI: 1912086182
Provider Name (Legal Business Name): BOONE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 S SHADY ST
MOUNTAIN CITY TN
37683-2015
US

IV. Provider business mailing address

345 DEERFIELD RD
BOONE NC
28607-5009
US

V. Phone/Fax

Practice location:
  • Phone: 828-355-3365
  • Fax:
Mailing address:
  • Phone: 828-355-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number332BP3500X
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number332BX2000X
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3020
License Number StateTN

VIII. Authorized Official

Name: SPENCER W HODGES
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 828-264-3055