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Organization
BOONEVILLE COMMUNITY PHARMACY OF MSINC
Active
Organization
BOONEVILLE COMMUNITY PHARMACY OF MSINC
Active
Other names
BOONEVILLE COMMUNITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TONY SMITH (OWNER)
(662) 728-1951
Entity
Organization
Contact information
Practice address
206 N 2ND ST, BOONEVILLE, MS 38829-2702
(662) 728-1951
(662) 728-1873
Mailing address
206 N 2ND ST, BOONEVILLE, MS 38829-2702
(662) 728-1951
(662) 728-1873
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
04785011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330527
—
MS
01
—
2520232
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/01/2006
Last updated
05/23/2023
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