Provider Demographics
NPI:1427365972
Name:MEDWINS PHARMACY INC
Entity Type:Organization
Organization Name:MEDWINS PHARMACY INC
Other - Org Name:DBA CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABISH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-419-7777
Mailing Address - Street 1:740 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4116
Mailing Address - Country:US
Mailing Address - Phone:863-419-7777
Mailing Address - Fax:863-419-7772
Practice Address - Street 1:740 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4116
Practice Address - Country:US
Practice Address - Phone:863-419-7777
Practice Address - Fax:863-419-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015039200Medicaid