Active NPI
Justin Booth, PHARMD.
- Pharmacist
- Mount Gay, WV
National Provider Identifier
1376846576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 7030
- Practice address
- US Route 119 Holden Road
Mount Gay, WV 25637-1264 - Phone
- (304) 239-2380
- Fax
- (304) 239-2384
- NPI assigned
- Dec 9, 2010
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7030 | WV | Primary |
| Pharmacist | 183500000X | 034037 | TN | |
| Pharmacist | 183500000X | 46090 | FL | |
| Pharmacist | 183500000X | 014618 | KY |
Addresses
Primary practice location
US Route 119 Holden Road
Mount Gay, WV 25637-1264
Mailing address
PO Box 1264
Mount Gay, WV 25637-1264
Phone (304) 239-2380
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46090 | FL | MD | Pharmacist |
| 014618 | KY | MD | Pharmacist |
| 034037 | TN | MD | Pharmacist |
| 7030 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291852800000",
"number": "1376846576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1264",
"city": "MOUNT GAY",
"state": "WV",
"postal_code": "256371264",
"telephone_number": "304-239-2380",
"fax_number": "304-239-2384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "US ROUTE 119 HOLDEN ROAD",
"city": "MOUNT GAY",
"state": "WV",
"postal_code": "256371264",
"telephone_number": "304-239-2380",
"fax_number": "304-239-2384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-09",
"last_updated": "2010-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "7030",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "034037",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "46090",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "014618",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Gay, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.