Provider Demographics
NPI:1619382249
Name:BOONE, REBECCA (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2800
Mailing Address - Country:US
Mailing Address - Phone:704-662-0611
Mailing Address - Fax:
Practice Address - Street 1:2420 SUPERCENTER DR NE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6426
Practice Address - Country:US
Practice Address - Phone:704-792-9830
Practice Address - Fax:704-792-9840
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC502445OtherNABP
NC09516OtherNCBOP