# LIL BOOS CORNER STORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lil Boos Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639619653
- **Authorized official:** ROBERT MADDOX IV (OWNER)
- **Authorized official phone:** (318) 793-2028

## Contact information

- **Practice address:** 415 ST. CLAIR RD. STE. C, BOYCE, LA 71409
- **Practice address phone:** (318) 793-2028
- **Practice address fax:** (859) 594-6639
- **Mailing address:** 415 ST. CLAIR ROAD; SUITE C, BOYCE, LA 71409
- **Mailing address phone:** (318) 793-2028
- **Mailing address fax:** (859) 594-6639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.007439-IR | LA | Yes |

## Other

- **Enumeration date:** 02/24/2017
- **Last updated:** 07/18/2023