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NPI Code Detail

MEDICARE: DR. TOMIE ANN BOACKLE PHARM.D.

MEDICARE: DR. TOMIE ANN BOACKLE PHARM.D.
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
1183500000XPharmacist13442AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113442OTHERALSTATE LICENSE NUMBER PHAR

General Provider Information

NPI Number : 1760481238
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TOMIE ANN BOACKLE PHARM.D.
Provider Business Mailing Address
First Line : 9580 MCPHERSON RD
Second Line :
City : WARRIOR
State : AL
Zip : 35180-2756
Country : US
Telephone Number : 205-590-4453
Fax Number :
Provider Business Practice Location Address
First Line : 619 19TH ST S
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35249-1900
Country : US
Telephone Number : 205-801-8732
Fax Number : 205-801-8741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/08/2007

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