Organization
GOODYKOONTZ DRUG STORES INC
Active
Other names
GOODYKOONTZ DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY BOVENIZER RPH (PRESIDENT)
(304) 324-7601
Entity
Organization
Contact information
Practice address
2924 EAST CUMBERLAND ROAD, BLUEFIELD, WV 24701
(304) 325-7121
(304) 327-9701
Mailing address
2924 EAST CUMBERLAND ROAD, BLUEFIELD, WV 24701
(304) 325-7121
(304) 327-9701
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0550098
WV
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085046995
—
VA
05
—
0141899000
—
WV
01
—
2109351
PK
—
Enumeration date
09/20/2006
Last updated
09/19/2016
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