MEDICARE: VIRGINIA BOOMERSHINE 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
1	183500000X	Pharmacist	S016677	AZ

General Provider Information

NPI Number	:	1790015972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA BOOMERSHINE PHARMD

Provider Business Mailing Address
First Line	:	2901 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2700
Country	:	US
Telephone Number	:	602-747-3094
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 N CENTRAL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2700
Country	:	US
Telephone Number	:	602-747-3094
Fax Number	:

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

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	11/29/2017

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Directions to “ VIRGINIA BOOMERSHINE PHARMD” Practice Location

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