Active NPI
Renee Jean Boles
- Pharmacist
- Clinton, MO
National Provider Identifier
1679186548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 043590
- Practice address
- 412 Pawnee St
Clinton, MO 64735-2481 - Phone
- (660) 885-4020
- Fax
- (660) 885-4095
- NPI assigned
- Aug 28, 2020
- Last updated
- Aug 28, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 043590 | MO | Primary |
Addresses
Primary practice location
412 Pawnee St
Clinton, MO 64735-2481
Mailing address
412 Pawnee St
Clinton, MO 64735-2481
Phone (660) 885-4020
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1679186548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 PAWNEE ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647352481",
"telephone_number": "660-885-4020",
"fax_number": "660-885-4095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 PAWNEE ST",
"city": "CLINTON",
"state": "MO",
"postal_code": "647352481",
"telephone_number": "660-885-4020",
"fax_number": "660-885-4095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLES",
"first_name": "RENEE",
"middle_name": "JEAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "043590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.