NPIMap

Organization Active NPI

Booth Pharmacy Inc

  • Community/Retail Pharmacy
  • Hawarden, IA
National Provider Identifier
1952343485
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
454 Issued in IA
Legal business name
BOOTH PHARMACY INC
Doing business as
Booth Pharmacy Inc
Practice address
903 Central Ave
Hawarden, IA 51023-2233
Phone
(712) 551-2374
Fax
(712) 551-1590
NPI assigned
Jun 11, 2006
Last updated
Dec 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

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

Authorized official

Name
Matt Hummel, RPHNPI 1548920077
Title
Owner
Phone
(712) 551-2374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 454 IA Primary

Addresses

Primary practice location

903 Central Ave
Hawarden, IA 51023-2233

Mailing address

PO Box 233
Hawarden, IA 51023-0233
Phone (712) 551-2374

Other identifiers 3

IdentifierTypeStateIssuer
2026597OtherPK
0048975MedicaidIA
8532660MedicaidSD

Other names 1

  • BOOTH PHARMACY INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930000177 IA DME Supplier - Pharmacy 4385761865 Practice locations: Hawarden, IA
O20180212000543 IA Part B Supplier - Pharmacy 4385761865 Practice locations: Hawarden, IA

National Provider Directory

National Provider Directory
Tax ID family
Booth Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

903 Central Ave
Hawarden, IA 51023
Phone (712) 551-2374

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1952343485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 233",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510230233",
            "telephone_number": "712-551-2374",
            "fax_number": "712-551-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 CENTRAL AVE",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510232233",
            "telephone_number": "712-551-2374",
            "fax_number": "712-551-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOTH PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "HUMMEL",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-551-2374",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2026597",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0048975",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8532660",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOOTH PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawarden, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; 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.