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NPI Code Detail

MEDICARE: DR. JUSTIN BOOTH PHARMD.

MEDICARE: DR. JUSTIN BOOTH 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
1183500000XPharmacist7030WV
2183500000XPharmacist034037TN
3183500000XPharmacist46090FL
4183500000XPharmacist014618KY

General Provider Information

NPI Number : 1376846576
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN BOOTH PHARMD.
Provider Business Mailing Address
First Line : PO BOX 1264
Second Line :
City : MOUNT GAY
State : WV
Zip : 25637-1264
Country : US
Telephone Number : 304-239-2380
Fax Number : 304-239-2384
Provider Business Practice Location Address
First Line : US ROUTE 119 HOLDEN ROAD
Second Line :
City : MOUNT GAY
State : WV
Zip : 25637-1264
Country : US
Telephone Number : 304-239-2380
Fax Number : 304-239-2384
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2010
Last Update Date : 12/09/2010

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Directions to “ DR. JUSTIN BOOTH PHARMD.” Practice Location

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