Provider Demographics
NPI:1598753550
Name:WINTER'S MAIN STREET DRUG
Entity Type:Organization
Organization Name:WINTER'S MAIN STREET DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-352-2036
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378
Mailing Address - Country:US
Mailing Address - Phone:320-352-2036
Mailing Address - Fax:320-352-2209
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378
Practice Address - Country:US
Practice Address - Phone:320-352-2036
Practice Address - Fax:320-352-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1128952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0165370001Medicare ID - Type Unspecified