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NPI Code Detail

MEDICARE: 1918 WINTER STREET OPERATING CO LLC

MEDICARE: 1918 WINTER STREET OPERATING CO LLC
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
1333600000XPharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1730937699
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1918 WINTER STREET OPERATING CO LLC
Provider Business Mailing Address
First Line : 7 CORPORATE DR
Second Line :
City : KEENE
State : NH
Zip : 03431-5042
Country : US
Telephone Number : 603-354-7000
Fax Number :
Provider Business Practice Location Address
First Line : 7405 S DURANGO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-3605
Country : US
Telephone Number : 702-407-2524
Fax Number : 702-407-2516
Authorized Official
Title or Position : AUTHORIZED PERSON
Name : KEVIN MCNAMARA
Credential :
Telephone Number : 603-354-4619
Provider Enumeration Date : 05/07/2024
Last Update Date : 07/24/2024

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Directions to “1918 WINTER STREET OPERATING CO LLC ” Practice Location

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