Provider Demographics
NPI:1992931984
Name:BOSTIC, TOMMIE F JR
Entity type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:F
Last Name:BOSTIC
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8825
Mailing Address - Country:US
Mailing Address - Phone:910-298-3161
Mailing Address - Fax:910-298-4572
Practice Address - Street 1:308 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8825
Practice Address - Country:US
Practice Address - Phone:910-298-3161
Practice Address - Fax:910-298-4572
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist