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Organization
KEVIN GLENN WURTZ
Active
Organization
KEVIN GLENN WURTZ
Active
Other names
PIONEER DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WURTZ RPH (OWNER)
(605) 356-3336
Entity
Organization
Contact information
Practice address
107 E MAIN ST, ELK POINT, SD 57025
(605) 356-3336
(605) 356-3202
Mailing address
PO BOX 489, ELK POINT, SD 57025-0489
(605) 356-3336
(605) 356-3202
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
100-0510
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301191
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8500840
—
SD
Enumeration date
11/22/2006
Last updated
08/19/2009
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