Healthcare Provider Details

I. General information

NPI: 1255637278
Provider Name (Legal Business Name): WINSLETTE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 SHORTER AVE NW
ROME GA
30165-1959
US

IV. Provider business mailing address

2444 SHORTER AVE NW
ROME GA
30165-1959
US

V. Phone/Fax

Practice location:
  • Phone: 706-290-0300
  • Fax: 706-290-0370
Mailing address:
  • Phone: 706-290-0300
  • Fax: 706-290-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE008006
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHRE008006
License Number StateGA

VIII. Authorized Official

Name: MR. WOOTSON KEITH WINSLETTE
Title or Position: PHARMACIST OWNER
Credential: R.PH.
Phone: 706-290-0300