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General NPI Number Information
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NPI Number | 1710073184
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Entity Type | Organization
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Legal Business Name | WINNSBORO DRUG STORE, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1213 COMMON ST
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City | WINNSBORO
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State | LA
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Zip | 71295-2609
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Country | US
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Telephone | 318-435-4311
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Fax | 318-435-3558
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Provider Business Mailing Address
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Address Line | 1213 COMMON ST
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City | WINNSBORO
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State | LA
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Zip | 71295-2609
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Country | US
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Telephone | 318-435-4311
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Fax | 318-435-3558
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Authorized Official
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Title or Position | PHARMASIST OWNER
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Name | MR. JERRY BREITHAUPT
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Credential | RPH
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Telephone | 318-435-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9084
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License Number State | LA
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