Provider Demographics
NPI:1467030551
Name:WINSLETTE, STEPHEN BRETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRETT
Last Name:WINSLETTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1959
Mailing Address - Country:US
Mailing Address - Phone:706-290-0300
Mailing Address - Fax:706-290-0370
Practice Address - Street 1:2444 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1959
Practice Address - Country:US
Practice Address - Phone:706-290-0300
Practice Address - Fax:706-290-0370
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH022089OtherGA PHARMACY LICENSE