Organization
BOOTH PHARMACY INC
Active
Organization
BOOTH PHARMACY INC
Active
Other names
BOOTH PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
MATT HUMMEL RPH (OWNER)
(712) 551-2374
Entity
Organization
Contact information
Practice address
903 CENTRAL AVE, HAWARDEN, IA 51023-2233
(712) 551-2374
(712) 551-1590
Mailing address
PO BOX 233, HAWARDEN, IA 51023-0233
(712) 551-2374
(712) 551-1590
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
454
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0048975
—
IA
01
—
2026597
PK
—
05
—
8532660
—
SD
Enumeration date
06/11/2006
Last updated
12/21/2016
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