BOONES CREEK PHARMACY, INC. (NPI# 1770199432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770199432 |
| Entity Type | Organization |
| Organization Name | BOONES CREEK PHARMACY, INC. |
| Practice Address |
4729 N Roan St Ste 2 Johnson City TN 37615-3886 |
| Practice Telephone | 4232830911 |
| Practice Fax Number | 4232830990 |
| Mailing Telephone | 4232830911 |
| Mailing Fax Number | 4232830990 |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |
| Authorized Official Name | MARK GUIMOND (OWNER/PIC/SEC&TREAS) |
| Authorized Official Telephone | 4232830911 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q036582 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073940334 | Boones Creek Pharmacy, Inc. | Pharmacy | 4729 N Roan St, Ste 2, Johnson City, TN 37615-3886 | 2013-10-02 |
| Street Address |
4729 N ROAN ST STE 2 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37615-3886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568962983 | Clayton Kilgore | Pharmacist | 208 Suncrest St Unit 1, Gray, TN 37615 | 2018-02-13 |
| 1346648268 | Jesse Mullins | Pharmacist | 121 Boone Ridge Dr, Suite 1006, Johnson City, TN 37615 | 2014-12-09 |
| 1750650875 | Medical Education Assistance Corporation | Pediatrics | 252 Sam Jenkins Rd, Attn: Dr. H. Patrick Stern, Gray, TN 37615 | 2011-12-19 |
| 1700018603 | Anna Lynne Deal | Nurse Practitioner | 119 Boone Ridge Dr., Ste. 201, Johnson City, TN 37615 | 2009-08-11 |
| 1285876631 | Leigh A Furman | Occupational Therapist | 253 Wiltshire Dr., Gray, TN 37615 | 2009-04-01 |
| 1811098908 | Fay Lynn Bembry | Nurse Practitioner | 119 Boone Ridge Drive Ste. 201, Johnson City, TN 37615 | 2006-09-25 |
| 1871528976 | Boones Creek Medical Pllc | Family Medicine | 2685 Boones Creek Road, Suite 104, Johnson City, TN 37615 | 2006-07-11 |
| 1568402048 | Joseph Vincent Pinyard Jr. | Family Medicine | 880 Boones Station Rd, Johnson City, TN 37615 | 2006-06-07 |
| 1548223084 | Pitchar Theerathorn | Internal Medicine | 119 Boone Ridge Drive, Suite 201, Johnson City, TN 37615 | 2006-04-07 |
| 1194717157 | Susan Kay Pennypacker | Nurse Practitioner | 140 Old Gray Station Rd, Suite 200, Gray, TN 37615 | 2005-08-16 |
| Find all providers in zip 37615 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043221625 | Pns Inc | Pharmacy | 527 N State of Franklin Rd, Suite 1, Johnson City, TN 37604-8210 | 2006-08-10 |
| 1386244085 | Jj Beans At Mooneys LLC | Pharmacy | 1107 N Roan St, Johnson City, TN 37601-3901 | 2020-10-30 |
| 1952477598 | Nhc Healthcare-johnson City LLC | Pharmacy | 3209 Bristol Hwy, Johnson City, TN 37601-1515 | 2006-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164032546 | Polaris Pharmacy Services of Tennessee, LLC | Pharmacy | 7005 Wesbelt Drive, Nashville, TN 32709 | 2020-07-31 |
| 1386261030 | Jeffrey Allan Anderson | Pharmacy | 721 N Tennessee Ave, Etowah, TN 37331-1754 | 2020-06-29 |
| 1376171652 | Boatwright Drug Co., Inc | Pharmacy | 7899 Leroy Boatwright St, Millington, TN 38053-2137 | 2020-03-31 |
| 1245868850 | Seymour Pharmacy Inc. | Pharmacy | 10721 Chapman Hwy Ste 6, Seymour, TN 37865-4771 | 2020-03-30 |
| 1700423654 | Southland Ltc Pharmacy | Pharmacy | 482 Interstate Dr Ste L, Manchester, TN 37355-3485 | 2019-12-10 |
| 1104380930 | Fannon Drug Co. | Pharmacy | 606 E. Emory Rd, Powell, TN 37849 | 2019-01-25 |
| 1538663281 | Black Bear Pharmacy, Inc. | Pharmacy | 110 Keith St Sw Ste 1and2, Cleveland, TN 37311-5868 | 2018-03-19 |
| 1891231734 | Rams Pharmacy LLC | Pharmacy | 1210 Hazelwood Dr Ste D, Smyrna, TN 37167-3964 | 2017-01-17 |
| 1982056529 | Pharmblue Tennessee LLC | Pharmacy | 1113 Murfreesboro Rd Ste 319-b, Franklin, TN 37064-1306 | 2016-07-07 |
| 1043685852 | Rams Pharmacy LLC | Pharmacy | 412 Gallatin Pike N, Madison, TN 37115-3706 | 2015-12-04 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.