Booneville Community Pharmacy of Msinc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

04785011 Issued in MS

Legal business name

BOONEVILLE COMMUNITY PHARMACY OF MSINC

Practice address

206 N 2ND St
Booneville, MS 38829-2702

Phone

(662) 728-1951

Fax

(662) 728-1873

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Tony Smith

Title

Owner

Phone

(662) 728-1951

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• BOONEVILLE COMMUNITY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Tax ID family

Booneville Community Pharmacy of Msinc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Booneville Community Pharmacy of Ms Inc.

  • Long Term Care Pharmacy
  • Booneville, MS
  • NPI 1972150472
  NPD tax ID

Locations

Practitioners 3

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

• Benjamin Sand

  • Pharmacist
  • Booneville, MS
  • NPI 1821867227
  NPD (past)
• Amira Rezk Smith, PHARM D

  • Pharmacist
  • Booneville, MS
  • NPI 1225112030
  NPD (past)
• Ginger G Tennison, PHARMD

  • Pharmacist
  • Booneville, MS
  • NPI 1962200618
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1679651186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388292702",
            "telephone_number": "662-728-1951",
            "fax_number": "662-728-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388292702",
            "telephone_number": "662-728-1951",
            "fax_number": "662-728-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONEVILLE COMMUNITY PHARMACY OF MSINC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-728-1951"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "04785011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330527",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2520232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOONEVILLE COMMUNITY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BOONEVILLE COMMUNITY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anna Bolton
• Booneville Anesthesia Services LLC
• Booneville Assisted Living LLC
• Booneville Chiropractic Clinic, P.a.
• Booneville Community Pharmacy of Ms Inc.
• Booneville Discount Drugs Inc
• Booneville General Dentistry, P.a.
• Booneville Internal Medicine PC
• Halley Box, APRN
• Brandon Johnson Booneville Anesthesia Services

• Community/Retail Pharmacy in Booneville, MS
• Providers in Booneville, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.