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NPI Code Detail

MEDICARE: WINONA BLDG. PHARMACY, INC.

MEDICARE: WINONA BLDG. PHARMACY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0004XCompounding Pharmacy60007748IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11531816OTHERINNAPB #

General Provider Information

NPI Number : 1699802082
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINONA BLDG. PHARMACY, INC.
Provider Business Mailing Address
First Line : PO BOX 88247
Second Line : 3266 N. MERIDIAN ST., #106
City : INDIANAPOLIS
State : IN
Zip : 46208-0247
Country : US
Telephone Number : 317-924-5551
Fax Number : 317-924-5573
Provider Business Practice Location Address
First Line : 3266 N MERIDIAN ST STE 106
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46208-5839
Country : US
Telephone Number : 317-924-5551
Fax Number : 317-924-5573
Authorized Official
Title or Position : OWNER
Name : MR. LAM Q NGUYEN
Credential :
Telephone Number : 317-590-0829
Provider Enumeration Date : 02/27/2007
Last Update Date : 08/22/2020

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