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General NPI Number Information
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NPI Number | 1952343485
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Entity Type | Organization
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Legal Business Name | BOOTH PHARMACY INC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 903 CENTRAL AVE
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City | HAWARDEN
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State | IA
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Zip | 51023-2233
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Country | US
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Telephone | 712-551-2374
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Fax | 712-551-1590
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Provider Business Mailing Address
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Address Line | PO BOX 233
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City | HAWARDEN
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State | IA
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Zip | 51023-0233
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Country | US
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Telephone | 712-551-2374
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Fax | 712-551-1590
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Authorized Official
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Title or Position | OWNER
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Name | MATT HUMMEL
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Credential | RPH
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Telephone | 712-551-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 454
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License Number State | IA
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