Healthcare Provider Details

I. General information

NPI: 1205792777
Provider Name (Legal Business Name): WINNY LA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 PASEO DEL PUEBLO SUR
TAOS NM
87571-5966
US

IV. Provider business mailing address

6735 LINDA VISTA BLVD
MISSOULA MT
59803-2769
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-2743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number105848
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010429
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: