Provider Demographics
NPI:1346782604
Name:WINFIELD PHARMACY INC
Entity Type:Organization
Organization Name:WINFIELD PHARMACY INC
Other - Org Name:WINFIELD PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLINNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-668-8891
Mailing Address - Street 1:37 WINFIELD PLAZA
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389
Mailing Address - Country:US
Mailing Address - Phone:636-668-8891
Mailing Address - Fax:636-668-8893
Practice Address - Street 1:37 WINFIELD PLAZA
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389
Practice Address - Country:US
Practice Address - Phone:636-668-8891
Practice Address - Fax:636-668-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20160404793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166224OtherPK
MO1346782604Medicaid