Kotzebue Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

04194 Issued in TX

Legal business name

KOTZEBUE DRUG INC

Doing business as

KOTZEBUE LEGEND DRUG

Practice address

525 N Saint Joseph St
Gonzales, TX 78629-4019

Phone

(830) 672-8505

Fax

(830) 672-8507

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Doug Kotzebue, RPH

Title

Owner and Pic

Phone

(830) 672-8505

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KOTZEBUE LEGEND DRUG Doing business as

Locations

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270080000000",
    "number": "1821134958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N SAINT JOSEPH ST",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786294019",
            "telephone_number": "830-672-8505",
            "fax_number": "830-672-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N SAINT JOSEPH ST",
            "city": "GONZALES",
            "state": "TX",
            "postal_code": "786294019",
            "telephone_number": "830-672-8505",
            "fax_number": "830-672-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOTZEBUE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2010-04-01",
        "status": "A",
        "authorized_official_last_name": "KOTZEBUE",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "OWNER AND PIC",
        "authorized_official_telephone_number": "830-672-8505",
        "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": "TX",
            "license": "04194",
            "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": "4521161",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4521161",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KOTZEBUE LEGEND DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Satya Kantipudi
• Catina Denise Kistler, CPHT
• Stephanie Lois Kodack, M.D.
• Kathleen Mary Koerner, D.O.
• Nancy Kay Konecny, LVN
• Brooke Nicole Krueger
• Verne Lagrega, LMSW
• Priscilla Layton, NP
• Leah Maltony
• Maria Isabel Martinez, LVN

• Community/Retail Pharmacy in Gonzales, TX
• Providers in Gonzales, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.