Healthcare Provider Details

I. General information

NPI: 1609418268
Provider Name (Legal Business Name): WINFIELD FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119C MAIN ST
POCA WV
25159-9602
US

IV. Provider business mailing address

PO BOX 962
POCA WV
25159-0962
US

V. Phone/Fax

Practice location:
  • Phone: 304-755-1500
  • Fax: 304-755-1528
Mailing address:
  • Phone: 304-755-1500
  • Fax: 304-755-1528

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 Number
License Number State

VIII. Authorized Official

Name: MR. BRAC BROWN
Title or Position: OWNER/RPH
Credential:
Phone: 304-550-1213