Active NPI
Joe Ray Bourn Sr., RPH
- Pharmacist
- Coffeeville, MS
National Provider Identifier
1033258264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E5330
- Practice address
- 31 Front St
Coffeeville, MS 38922 - Phone
- (662) 675-2775
- Fax
- (662) 675-8477
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E5330 | MS | Primary |
Addresses
Primary practice location
31 Front St
Coffeeville, MS 38922
Mailing address
PO Box 279
Coffeeville, MS 38922
Phone (662) 675-2775
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2502880 | Other | NABP # FED | |
| 0093220 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E5330 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yalobusha General Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Coffeeville, MS
- NPI 1154465912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033258264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 279",
"city": "COFFEEVILLE",
"state": "MS",
"postal_code": "38922",
"telephone_number": "662-675-2775",
"fax_number": "662-675-8477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 FRONT ST",
"city": "COFFEEVILLE",
"state": "MS",
"postal_code": "38922",
"telephone_number": "662-675-2775",
"fax_number": "662-675-8477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURN",
"first_name": "JOE",
"middle_name": "RAY",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E5330",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP # FED",
"identifier": "2502880",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0093220",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coffeeville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.