Provider Demographics
NPI:1104556943
Name:BOONE, MICHAEL MENCHACA (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MENCHACA
Last Name:BOONE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 DUNLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3315
Mailing Address - Country:US
Mailing Address - Phone:469-496-1818
Mailing Address - Fax:
Practice Address - Street 1:451 FM 548
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6288
Practice Address - Country:US
Practice Address - Phone:972-552-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist