Healthcare Provider Details

I. General information

NPI: 1811226459
Provider Name (Legal Business Name): ANGELA WINKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY # 71 PHARMACY DEPT (119)
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

PO BOX 69004 PHARMACY DEPT (119)
ALEXANDRIA LA
71306-9004
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax: 318-483-5013
Mailing address:
  • Phone: 318-473-0010
  • Fax: 318-483-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number017210
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: