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General NPI Number Information
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NPI Number | 1821343369
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Entity Type | Individual
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Provider Name | JUSTIN LEE BOONE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 151 W GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45216-1015
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Country | US
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Telephone | 513-418-2690
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Fax |
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Provider Business Mailing Address
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Address Line | 6718 BOXWOOD LN APARTMENT D
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-1125
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Country | US
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Telephone | 513-532-3316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03132046
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License Number State | OH
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