Healthcare Provider Details

I. General information

NPI: 1629129457
Provider Name (Legal Business Name): ROY EUGENE WINTERS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1HALS PLAZA
PIEDMONT MO
63957
US

IV. Provider business mailing address

14524 HIGHWAY 67 N
WILLIAMSVILLE MO
63967-8247
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-4823
  • Fax: 573-223-2665
Mailing address:
  • Phone: 573-998-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28905
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: