# BOONEVILLE COMMUNITY PHARMACY OF MSINC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BOONEVILLE COMMUNITY PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679651186
- **Authorized official:** TONY SMITH (OWNER)
- **Authorized official phone:** (662) 728-1951

## Contact information

- **Practice address:** 206 N 2ND ST, BOONEVILLE, MS 38829-2702
- **Practice address phone:** (662) 728-1951
- **Practice address fax:** (662) 728-1873
- **Mailing address:** 206 N 2ND ST, BOONEVILLE, MS 38829-2702
- **Mailing address phone:** (662) 728-1951
- **Mailing address fax:** (662) 728-1873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 04785011 | MS | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 05/23/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330527 | — | MS |
| 01 | — | 2520232 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |