# KEVIN GLENN WURTZ

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PIONEER DRUG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306911599
- **Authorized official:** KEVIN WURTZ RPH (OWNER)
- **Authorized official phone:** (605) 356-3336

## Contact information

- **Practice address:** 107 E MAIN ST, ELK POINT, SD 57025
- **Practice address phone:** (605) 356-3336
- **Practice address fax:** (605) 356-3202
- **Mailing address:** PO BOX 489, ELK POINT, SD 57025-0489
- **Mailing address phone:** (605) 356-3336
- **Mailing address fax:** (605) 356-3202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 100-0510 | SD | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 08/19/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4301191 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 8500840 | — | SD |