Active NPI
Brad Lee Boerio, R.PH.
- Pharmacist
- Boonville, MO
National Provider Identifier
1992305783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 041223
- Practice address
- 2150 Main St
Boonville, MO 65233-1941 - Phone
- (660) 882-6552
- Fax
- (660) 882-6725
- NPI assigned
- Oct 29, 2020
- Last updated
- Oct 29, 2020
- Sex
- Male
- 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 | 041223 | MO | Primary |
Addresses
Primary practice location
2150 Main St
Boonville, MO 65233-1941
Mailing address
2150 Main St
Boonville, MO 65233-1941
Phone (660) 882-6552
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041223 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | 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.
-
dba Walmart Pharmacy 10-0820
- Community/Retail Pharmacy
- Boonville, MO
- NPI 1043237365
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1992305783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2150 MAIN ST",
"city": "BOONVILLE",
"state": "MO",
"postal_code": "652331941",
"telephone_number": "660-882-6552",
"fax_number": "660-882-6725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2150 MAIN ST",
"city": "BOONVILLE",
"state": "MO",
"postal_code": "652331941",
"telephone_number": "660-882-6552",
"fax_number": "660-882-6725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERIO",
"first_name": "BRAD",
"middle_name": "LEE",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-29",
"last_updated": "2020-10-29",
"certification_date": "2020-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "041223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boonville, MO
- Ashley Manor, Inc. (Ashley Manor Care Center)
- Elizabeth Anne Atkinson, LPC
- Axis Chiropractic LLC
- Patrick C Beglau, LPC
- Jeff Birdsong, O.D.
- Shauna Lea Bohlken, APRN-CNP
- Boone Physician Services LLC (Boone Health Primary Care - Boonville)
- Boonville Chiropractic LLC
- Boonville No 1 Inc (Lakeview Health Care & Rehabilitation Center)
- Boonville No2 Inc (Riverdell Care Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.