Boomer Solutions LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

48-6828 Issued in OK

Legal business name

BOOMER SOLUTIONS LLC

Practice address

310 S 1St St
Eufaula, OK 74432-3202

Phone

(877) 774-3706

Fax

(888) 852-2946

NPI assigned

Mar 9, 2010

Organization subpart

No

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

Authorized official

Name

Kyle Simmons, PHARM D.NPI 1609173558

Title

Pharmacy Manager

Phone

(877) 774-3706

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Boomer Solutions Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Matthew Simmons, PHARM D.

  • Pharmacist
  • Eufaula, OK
  • NPI 1609173558
  NPD (past) Authorized official
• Tanner Burke Corsini, PHARMD

  • Pharmacist
  • Eufaula, OK
  • NPI 1992476782
  NPD

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1477876159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S 1ST ST",
            "city": "EUFAULA",
            "state": "OK",
            "postal_code": "744323202",
            "telephone_number": "877-774-3706",
            "fax_number": "888-852-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S 1ST ST",
            "city": "EUFAULA",
            "state": "OK",
            "postal_code": "744323202",
            "telephone_number": "877-774-3706",
            "fax_number": "888-852-2946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOMER SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "877-774-3706",
        "authorized_official_credential": "PHARM D."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OK",
            "license": "48-6828",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124945",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200286150A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boomer Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Eufaula, OK
• Long Term Care Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; 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.