Organization
FIKES BOOMTOWN DRUG, INC.
Active
Other names
Boomtown Drug
Organization subpart
No
Provider details
NPI number
Authorized official
CORY FIKES D.PH. (PRESIDENT/OWNER)
(940) 569-5600
Entity
Organization
Contact information
Practice address
514 S. OKLAHOMA CUTOFF, BURKBURNETT, TX 76354
(940) 569-5600
(940) 569-5608
Mailing address
PO BOX 805, BURKBURNETT, TX 76354-0805
(940) 569-5600
(940) 569-5608
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
25627
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4545351
NCPDP
TX
Enumeration date
07/24/2007
Last updated
07/24/2007
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