Provider Demographics
NPI:1427556307
Name:WINDHAM PHARMA INC
Entity Type:Organization
Organization Name:WINDHAM PHARMA INC
Other - Org Name:WINDHAM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMATULASI
Authorized Official - Middle Name:RATNAM
Authorized Official - Last Name:ATTANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-734-3033
Mailing Address - Street 1:61 STATE ROUTE 296
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12496-5308
Mailing Address - Country:US
Mailing Address - Phone:518-734-3033
Mailing Address - Fax:518-734-6575
Practice Address - Street 1:61 STATE ROUTE 296
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NY
Practice Address - Zip Code:12496-5308
Practice Address - Country:US
Practice Address - Phone:518-734-3033
Practice Address - Fax:518-734-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy