MEDICARE: MR. BILLY BRUCE BOUGHTON RPH

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
1	1835X0200X	Oncology Pharmacist	34661	TX

General Provider Information

NPI Number	:	1518037985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BILLY BRUCE BOUGHTON RPH

Provider Business Mailing Address
First Line	:	2819 N FITZHUGH AVE
Second Line	:	#2302
City	:	DALLAS
State	:	TX
Zip	:	75204-3144
Country	:	US
Telephone Number	:	214-728-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 WORTH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2006
Country	:	US
Telephone Number	:	214-370-1602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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