Provider Demographics
NPI:1477517589
Name:WINTER PARK DISCOUNT DRUG NILKANTH INC.
Entity Type:Organization
Organization Name:WINTER PARK DISCOUNT DRUG NILKANTH INC.
Other - Org Name:WINTER PARK DRUG STORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:URMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-667-3791
Mailing Address - Street 1:5220 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7056
Mailing Address - Country:US
Mailing Address - Phone:910-791-2346
Mailing Address - Fax:910-791-6885
Practice Address - Street 1:5220 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7056
Practice Address - Country:US
Practice Address - Phone:910-791-2346
Practice Address - Fax:910-791-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720605553Medicaid
NC0656033Medicaid
1267340001Medicare NSC