Organization
KOTZEBUE DRUG INC
Active
Organization
KOTZEBUE DRUG INC
Active
Other names
KOTZEBUE LEGEND DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG KOTZEBUE RPH (OWNER AND PIC)
(830) 672-8505
Entity
Organization
Contact information
Practice address
525 N SAINT JOSEPH ST, GONZALES, TX 78629-4019
(830) 672-8505
(830) 672-8507
Mailing address
525 N SAINT JOSEPH ST, GONZALES, TX 78629-4019
(830) 672-8505
(830) 672-8507
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
04194
TX
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4521161
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
4521161
—
TX
Enumeration date
01/29/2007
Last updated
04/01/2010
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