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NPI Code Detail

MEDICARE: MR. MARK ALAN WYNTERS CPHT

MEDICARE: MR. MARK ALAN WYNTERS CPHT
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
1183700000XPharmacy Technician67034956AIN
2183700000XPharmacy Technician049274552IL

General Provider Information

NPI Number : 1942891171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK ALAN WYNTERS CPHT
Provider Business Mailing Address
First Line : 417 GREENBRIAR DR APT 3
Second Line :
City : NORMAL
State : IL
Zip : 61761-2232
Country : US
Telephone Number : 573-462-0810
Fax Number :
Provider Business Practice Location Address
First Line : 2225 W MARKET ST
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61705-5014
Country : US
Telephone Number : 309-828-8626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2021
Last Update Date : 09/28/2021

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