Organization
FIKES BOOMTOWN DRUG
Active
Other names
Boomtown Drug
Organization subpart
No
Provider details
NPI number
Authorized official
CORY GENE FIKES D.PH. (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
3336C0003X
Community/Retail Pharmacy
Primary
25627
TX
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145823
—
TX
05
—
200114870A
—
OK
01
—
25627
STATE LICENSE #
TX
01
—
4545351
NCPDP NUMBER
TX
Enumeration date
07/10/2007
Last updated
03/07/2023
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