Provider Demographics
NPI:1114437936
Name:WINTER SPRINGS PHARMACY LLC
Entity Type:Organization
Organization Name:WINTER SPRINGS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:MCCREIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-316-4615
Mailing Address - Street 1:5942 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5035
Mailing Address - Country:US
Mailing Address - Phone:321-316-4615
Mailing Address - Fax:321-316-4619
Practice Address - Street 1:5942 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5035
Practice Address - Country:US
Practice Address - Phone:321-316-4615
Practice Address - Fax:321-316-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015055100Medicaid