NPIMap

Organization Active NPI

Boones Pharmacy Inc

  • Community/Retail Pharmacy
  • Demopolis, AL
National Provider Identifier
1356579205
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
113281 Issued in AL
Legal business name
BOONES PHARMACY INC
Practice address
951B US Highway 80 W
Demopolis, AL 36732-4102
Phone
(334) 289-8989
Fax
(334) 289-3276
NPI assigned
Jun 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raymond Boone, RPH
Title
Owner/Pic/Ao
Phone
(334) 289-8989

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 113281 AL Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

951B US Highway 80 W
Demopolis, AL 36732-4102

Mailing address

951B US Highway 80 W
Demopolis, AL 36732-4102
Phone (334) 289-8989

Other identifiers 2

IdentifierTypeStateIssuer
1356579205MedicaidAL
2120908OtherPK

Other names 1

  • Boone's Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150224001444 AL Part B Supplier - Mass Immunization (Roster Biller Only) 2769642479 Practice locations: Demopolis, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

951 US Highway 80 W
#B
Demopolis, AL 36732
Phone (334) 289-8989

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1356579205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951B US HIGHWAY 80 W",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367324102",
            "telephone_number": "334-289-8989",
            "fax_number": "334-289-3276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951B US HIGHWAY 80 W",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "367324102",
            "telephone_number": "334-289-8989",
            "fax_number": "334-289-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONES PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER/PIC/AO",
        "authorized_official_telephone_number": "334-289-8989",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113281",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356579205",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120908",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boone's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boone's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Demopolis, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.