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General NPI Number Information
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NPI Number | 1144334889
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Entity Type | Organization
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Legal Business Name | GENE WINDOM INC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12302 ROPER BLVD UNIT 106 & 107
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City | CLERMONT
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State | FL
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Zip | 34711-8515
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Country | US
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Telephone | 352-243-6340
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Fax | 352-243-6596
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Provider Business Mailing Address
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Address Line | 12302 ROPER BLVD UNIT 106 & 107
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City | CLERMONT
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State | FL
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Zip | 34711-8515
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Country | US
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Telephone | 352-243-6340
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Fax | 352-243-6596
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GENE WINDOM
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Credential | R.PH.
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Telephone | 352-243-6340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH22192
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | FL
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