Lil Boos Corner Store LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY.007439-IR Issued in LA

Legal business name

LIL BOOS CORNER STORE LLC

Doing business as

Lil Boos Pharmacy

Practice address

415 St. Clair Rd. Ste. C
Boyce, LA 71409

Phone

(318) 793-2028

Fax

(859) 594-6639

NPI assigned

Feb 24, 2017

Last updated

Jul 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Maddox IV

Title

Owner

Phone

(318) 793-2028

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Lil Boos Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

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

{
    "created_epoch": "1487894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1639619653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 ST. CLAIR ROAD; SUITE C",
            "city": "BOYCE",
            "state": "LA",
            "postal_code": "71409",
            "telephone_number": "318-793-2028",
            "fax_number": "859-594-6639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 ST. CLAIR RD. STE. C",
            "city": "BOYCE",
            "state": "LA",
            "postal_code": "71409",
            "telephone_number": "318-793-2028",
            "fax_number": "859-594-6639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIL BOOS CORNER STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-24",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A",
        "authorized_official_last_name": "MADDOX IV",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-793-2028"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY.007439-IR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168053",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2204980",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lil Boos Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Boyce, LA
• Providers in Boyce, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.