Healthcare Provider Details

I. General information

NPI: 1356514632
Provider Name (Legal Business Name): WINDHAM DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1610
US

IV. Provider business mailing address

1605 S HIGHWAY 25 W
WILLIAMSBURG KY
40769-1610
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-3636
  • Fax: 606-549-9155
Mailing address:
  • Phone: 606-549-3636
  • Fax: 606-549-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07247
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN SMITH
Title or Position: VICE-PRESIDENT
Credential: PHARMD
Phone: 606-549-3636