Provider Demographics
NPI:1215072020
Name:BOONE, BRADLEY A (PHARM D)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:BOONE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S MAIN ST
Mailing Address - Street 2:PO BOX 437
Mailing Address - City:MARION
Mailing Address - State:KY
Mailing Address - Zip Code:42064-0437
Mailing Address - Country:US
Mailing Address - Phone:270-967-9007
Mailing Address - Fax:270-967-9008
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1545
Practice Address - Country:US
Practice Address - Phone:270-967-9007
Practice Address - Fax:270-967-9008
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist