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NPI Code Detail

MEDICARE: DR. LUTHER BOYD KOON PHARMD

MEDICARE: DR. LUTHER BOYD KOON PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0000041091TN
2183500000XPharmacistE-14903MS

General Provider Information

NPI Number : 1093003972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUTHER BOYD KOON PHARMD
Provider Business Mailing Address
First Line : 5148 HIGHWAY 51 N
Second Line :
City : SENATOBIA
State : MS
Zip : 38668-1720
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2154 GOODMAN RD W
Second Line :
City : HORN LAKE
State : MS
Zip : 38637-1303
Country : US
Telephone Number : 662-393-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2011
Last Update Date : 05/23/2019

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