Healthcare Provider Details

I. General information

NPI: 1902900962
Provider Name (Legal Business Name): WINCHESTER COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E GREENVILLE AVE SUITE 300
WINCHESTER IN
47394-9436
US

IV. Provider business mailing address

409 E GREENVILLE AVE SUITE 300
WINCHESTER IN
47394-9436
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-5410
  • Fax: 765-584-5436
Mailing address:
  • Phone: 765-584-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005902A
License Number StateIN

VIII. Authorized Official

Name: MAX BARNHART
Title or Position: DIRECTOR CHS COMM PHRMCY NTWRK
Credential:
Phone: 765-751-5316