1366502841 NPI number — PHARMACY SERVICES OF WINNFIELD INC

Table of content: (NPI 1366502841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366502841 NPI number — PHARMACY SERVICES OF WINNFIELD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACY SERVICES OF WINNFIELD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHARMACY SERVICES OF WINNFIELD VITAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366502841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-447-4095
Provider Business Mailing Address Fax Number:
601-482-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-628-3536
Provider Business Practice Location Address Fax Number:
318-628-3576
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
RALPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
318-628-3536

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 5357-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1261947 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1271900 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1924453 . This is a "NABP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7212212630 . This is a "BCBS DME" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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