Healthcare Provider Details

I. General information

NPI: 1730841115
Provider Name (Legal Business Name): WINONA PHARMACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FILER AVE STE 2
TWIN FALLS ID
83301-4008
US

IV. Provider business mailing address

615 FILER AVE STE 2
TWIN FALLS ID
83301-4008
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-4485
  • Fax: 208-733-4186
Mailing address:
  • Phone: 208-733-4485
  • Fax: 208-733-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL S FUCHS
Title or Position: MEMBER/RPH
Credential: RPH
Phone: 208-733-4485