Provider Demographics
NPI:1144334889
Name:GENE WINDOM INC
Entity type:Organization
Organization Name:GENE WINDOM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-243-6340
Mailing Address - Street 1:12302 ROPER BLVD
Mailing Address - Street 2:UNIT 106 & 107
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8515
Mailing Address - Country:US
Mailing Address - Phone:352-243-6340
Mailing Address - Fax:352-243-6596
Practice Address - Street 1:12302 ROPER BLVD
Practice Address - Street 2:UNIT 106 & 107
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8515
Practice Address - Country:US
Practice Address - Phone:352-243-6340
Practice Address - Fax:352-243-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22192333600000X
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031651200Medicaid
FL1020558OtherNCPDP #
FLBG9928714OtherDEA #
FL1020558OtherNCPDP #
FLBG9928714OtherDEA #