Healthcare Provider Details

I. General information

NPI: 1518360759
Provider Name (Legal Business Name): WINSTON BATCHELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N PINE ST
DEQUINCY LA
70633-3531
US

IV. Provider business mailing address

129 N PINE ST
DEQUINCY LA
70633-3531
US

V. Phone/Fax

Practice location:
  • Phone: 337-786-6111
  • Fax: 337-786-4499
Mailing address:
  • Phone: 337-786-6111
  • Fax: 337-786-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.011651
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: