MEDICARE: MRS. LAUREN MEGAN BOONE 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	183500000X	Pharmacist	015638	KY

General Provider Information

NPI Number	:	1699058776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN MEGAN BOONE RPH

Provider Business Mailing Address
First Line	:	537 CHEROKEE DR
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42103-1305
Country	:	US
Telephone Number	:	731-819-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 W 4TH ST
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-1324
Country	:	US
Telephone Number	:	270-726-1881
Fax Number	:

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

Provider Enumeration Date	:	09/24/2011
Last Update Date	:	09/24/2011

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