NPI Code Detail JSON Logo

1417054255 NPI number — GOODYKOONTZ DRUG STORES INC

NPI Number: 1417054255
Health Care Provider/Practitioner: GOODYKOONTZ DRUG STORES INC

Information about “1417054255” NPI (GOODYKOONTZ DRUG STORES INC) exists in 1417054255 in HTML format HTML  |  1417054255 in plain Text format TXT  |  1417054255 in PDF (Portable Document Format) PDF  |  1417054255 in an XML format XML  formats.

NPI Number : 1417054255 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417054255",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GOODYKOONTZ DRUG STORES INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2924 EAST CUMBERLAND ROAD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BLUEFIELD",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "24701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-325-7121",
    "MailingAddressFaxNumber": "304-327-9701",
    "FirstLinePracticeLocationAddress": "2924 EAST CUMBERLAND ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLUEFIELD",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "24701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-325-7121",
    "PracticeLocationAddressFaxNumber": "304-327-9701",
    "EnumerationDate": "09/20/2006",
    "LastUpdateDate": "09/19/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BOVENIZER",
    "AuthorizedOfficialFirstName": "JERRY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RPH",
    "AuthorizedOfficialTelephoneNumber": "304-324-7601",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "SP0550098",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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