Active NPI
James Guillermo Boonstra
- Pharmacist
- Tyler, TX
National Provider Identifier
1558641845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 33748
- Practice address
- 619 Court RDG
Tyler, TX 75703-5908 - Phone
- (903) 245-0671
- NPI assigned
- Aug 18, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 33748 | TX | Primary |
Addresses
Primary practice location
619 Court RDG
Tyler, TX 75703-5908
Mailing address
619 Court RDG
Tyler, TX 75703-5908
Phone (903) 245-0671
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33748 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1558641845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "619 COURT RDG",
"city": "TYLER",
"state": "TX",
"postal_code": "757035908",
"telephone_number": "903-245-0671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 COURT RDG",
"city": "TYLER",
"state": "TX",
"postal_code": "757035908",
"telephone_number": "903-245-0671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOONSTRA",
"first_name": "JAMES",
"middle_name": "GUILLERMO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-18",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "33748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.