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General NPI Number Information
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NPI Number | 1184725350
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Entity Type | Organization
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Legal Business Name | WINN DIXIE PHARMACY
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14595 MILITARY TRL
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City | DELRAY BEACH
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State | FL
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Zip | 33484-3730
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Country | US
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Telephone | 561-637-2364
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Fax |
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Provider Business Mailing Address
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Address Line | 10004 WINDING LAKE RD APT 102
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City | SUNRISE
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State | FL
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Zip | 33351-5834
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Country | US
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Telephone | 954-749-3518
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACY
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Name | KEVIN M ELLIS
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Credential | PHARM-D
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Telephone | 561-637-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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