NPIMap

Organization Active NPI

Booth Pharmacy

  • Pharmacist
  • Hawarden, IA
National Provider Identifier
1447334701
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
454 Issued in IA
Legal business name
BOOTH PHARMACY
Practice address
903 Central Ave
Hawarden, IA 51023-2233
Phone
(712) 551-2374
Fax
(712) 551-1590
NPI assigned
Oct 24, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Matthew Scott Hummel, R. PH.
Title
Pharmacist
Phone
(712) 551-2374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 454 IA Primary

Addresses

Primary practice location

903 Central Ave
Hawarden, IA 51023-2233

Mailing address

903 Central Ave
P.O. Box 233
Hawarden, IA 51023-2233
Phone (712) 551-2374

Other identifiers 1

IdentifierTypeStateIssuer
0048975MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Booth Pharmacy Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

903 Central Ave
Hawarden, IA 51023
Phone (712) 551-2374

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447334701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 CENTRAL AVE",
            "address_2": "P.O. BOX 233",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510232233",
            "telephone_number": "712-551-2374",
            "fax_number": "712-551-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 CENTRAL AVE",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510232233",
            "telephone_number": "712-551-2374",
            "fax_number": "712-551-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOTH PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUMMEL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "712-551-2374",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0048975",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawarden, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.