NPIMap

Organization Active NPI

Fikes Boomtown Drug

Doing business as Boomtown Drug

  • Community/Retail Pharmacy
  • Burkburnett, TX
National Provider Identifier
1902004112
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
25627 Issued in TX
Legal business name
FIKES BOOMTOWN DRUG
Doing business as
Boomtown Drug
Practice address
514 S. Oklahoma Cutoff
Burkburnett, TX 76354
Phone
(940) 569-5600
Fax
(940) 569-5608
NPI assigned
Jul 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Cory Gene Fikes, D.PH.
Title
Owner
Phone
(940) 569-5600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 25627 TX Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

514 S. Oklahoma Cutoff
Burkburnett, TX 76354

Mailing address

PO Box 805
Burkburnett, TX 76354-0805
Phone (940) 569-5600

Other identifiers 4

IdentifierTypeStateIssuer
25627OtherTXSTATE LICENSE #
200114870AMedicaidOK
4545351OtherTXNCPDP NUMBER
145823MedicaidTX

Other names 1

  • Boomtown Drug Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090325000589 TX Part B Supplier - Mass Immunization (Roster Biller Only) 7810054459 Practice locations: Burkburnett, TX
O20100930098233 TX DME Supplier - Pharmacy 7810054459 Practice locations: Burkburnett, TX

National Provider Directory

National Provider Directory
Tax ID family
Boomtown Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

514 S Oklahoma Cut Off
Burkburnett, TX 76354
Phone (940) 569-5600

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1902004112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 805",
            "city": "BURKBURNETT",
            "state": "TX",
            "postal_code": "763540805",
            "telephone_number": "940-569-5600",
            "fax_number": "940-569-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 S. OKLAHOMA CUTOFF",
            "city": "BURKBURNETT",
            "state": "TX",
            "postal_code": "76354",
            "telephone_number": "940-569-5600",
            "fax_number": "940-569-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIKES BOOMTOWN DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-10",
        "last_updated": "2023-03-07",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "FIKES",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "940-569-5600",
        "authorized_official_credential": "D.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "25627",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "25627",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200114870A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "4545351",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145823",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boomtown Drug",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boomtown Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burkburnett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.