Healthcare Provider Details

I. General information

NPI: 1982701819
Provider Name (Legal Business Name): MED WIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 MAIN ST
WINCHESTER MA
01890-1953
US

IV. Provider business mailing address

568 MAIN ST
WINCHESTER MA
01890-1953
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-1940
  • Fax: 781-729-3460
Mailing address:
  • Phone: 781-729-1940
  • Fax: 781-729-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1107
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CATHLEEN CAMUSO
Title or Position: OWNER
Credential:
Phone: 781-729-1940