Boones Creek Pharmacy, Inc.
Organization Active NPI Community/Retail Pharmacy · Johnson City, TN
NPI 1073940334 · NPPES record last updated Apr 28, 2026
Key facts
- NPI
- 1073940334
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0000002064 (TN)
- Legal business name
- BOONES CREEK PHARMACY, INC.
- Practice address
- 4729 N Roan St
Ste 2
Johnson City, TN 37615-3886 - Phone
- (423) 283-0911
- Fax
- (423) 283-0990
- NPI assigned
- Oct 2, 2013
- Organization subpart
- No
Authorized official
- Name
- Caden Cox, PHARMD
- Title
- Owner/Pic
- Phone
- (423) 283-0911
Corporate family (same tax ID) 1
Member of 1
Practitioners 2
-
Caden Walker Cox, PHARMD
-
Mark Guimond, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160914002361 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 5597051771 | Practice locations: Johnson City, TN |
National Provider Directory
- Tax ID family
- Boones Creek Pharmacy
Locations
4729 N Roan St
Ste 2
Johnson City, TN 37615
Phone (423) 283-0911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0000002064 | TN | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
4729 N Roan St
Ste 2
Johnson City, TN 37615-3886
Mailing address
4729 N Roan St Ste 2
Johnson City, TN 37615-3733
Phone (423) 283-0911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2142795 | Other | PK |
Other names
- Boones Creek Pharmacy
Other providers in Johnson City, TN
- Samantha Bookbinder
- Eric Bookout
- Amanda F Boone
- Boones Creek Dentistry
- Boones Creek Medical PLLC
- Boones Creek Pharmacy, Inc.
- Sarah Elizabeth Boop
- Teddy Wayne Booth II
- Thomas R. Borthwick
- Britny King Boswell Hall
All providers in Johnson City, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.