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General NPI Number Information
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NPI Number | 1194245837
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHARMACY OF WINNSBORO
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 3326 FRONT ST STE D
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City | WINNSBORO
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State | LA
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Zip | 71295-6406
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Country | US
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Telephone | 318-435-9681
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Fax | 318-435-9065
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Provider Business Mailing Address
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Address Line | PO BOX 1350
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City | WINNSBORO
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State | LA
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Zip | 71295-1350
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Country | US
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Telephone | 318-412-0349
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Fax |
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Authorized Official
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Title or Position | ACCOUNTING MANAGER
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Name | MRS. KAYE WALLER
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Credential |
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Telephone | 318-412-0349
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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 | PHY.007500-IR
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License Number State | LA
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