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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