Provider Demographics
NPI:1073766093
Name:WINTERS LONG TERM CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:WINTERS LONG TERM CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-777-0609
Mailing Address - Street 1:PO BOX 6680
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-6680
Mailing Address - Country:US
Mailing Address - Phone:816-777-0609
Mailing Address - Fax:
Practice Address - Street 1:121 EXPRESS LN
Practice Address - Street 2:SUITE B
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1383
Practice Address - Country:US
Practice Address - Phone:913-250-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINTERS PHARMACIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-102183336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy