Goodykoontz Drug Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

SP0550098 Issued in WV

Legal business name

GOODYKOONTZ DRUG STORES INC

Doing business as

GOODYKOONTZ DRUG STORE INC

Practice address

2924 East Cumberland Road
Bluefield, WV 24701

Phone

(304) 325-7121

Fax

(304) 327-9701

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerry Bovenizer, RPH

Title

President

Phone

(304) 324-7601

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• GOODYKOONTZ DRUG STORE INC Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Lohr

  • Pharmacist
  • Bluefield, WV
  • NPI 1649525676
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1417054255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2924 EAST CUMBERLAND ROAD",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "24701",
            "telephone_number": "304-325-7121",
            "fax_number": "304-327-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 EAST CUMBERLAND ROAD",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "24701",
            "telephone_number": "304-325-7121",
            "fax_number": "304-327-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODYKOONTZ DRUG STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "BOVENIZER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-324-7601",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "SP0550098",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085046995",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0141899000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2109351",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOODYKOONTZ DRUG STORE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Harold Lee Goforth Jr., D.D.S.
• Deborah Goins
• Emaleigh Madison Goins, RN
• Ronald Goins
• Kelli Nicole Golden
• Jessica Jones Gotham, CRNA
• Alexis Graham
• Erica Danielle-Ellis Graham
• Matthew Green, PHARM.D.
• Naomi Elizabeth Green

• Community/Retail Pharmacy in Bluefield, WV
• Providers in Bluefield, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.