=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871841866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW JEFFREY WINCHELL PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2012
-----------------------------------------------------
Last Update Date | 08/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 891 ROUTE 9
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-1744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-793-0514
-----------------------------------------------------
Fax | 518-793-0642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 891 ROUTE 9
-----------------------------------------------------
City | QUEENSBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12804-1744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-793-0514
-----------------------------------------------------
Fax | 518-793-0642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 057256
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------