James Guillermo Boonstra | Tyler, TX • PECOS Search

James Guillermo Boonstra

Pharmacist

Pharmacy Service Providers

619 Court Rdg, Tyler, TX 75703-5908

PECOS Enrollment

Based on the most recent information from CMS, provider James Guillermo Boonstra does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1558641845
Provider Type
Individual
Full Name
Boonstra, James Guillermo
Gender
Male

Sole Proprietor
Yes
Enumeration Date
8/18/2011
Last Updated
8/18/2011

Contact Information

Practice Location

619 Court Rdg, Tyler, TX 75703-5908

Unlisted Fax

Mailing Location

619 Court Rdg, Tyler, TX 75703-5908

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 183500000X Primary	Description Pharmacist Pharmacy Service Providers	License 33748 Texas