Provider Demographics
NPI:1609418268
Name:WINFIELD FAMILY PHARMACY
Entity Type:Organization
Organization Name:WINFIELD FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-550-1213
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:POCA
Mailing Address - State:WV
Mailing Address - Zip Code:25159-0962
Mailing Address - Country:US
Mailing Address - Phone:304-755-1500
Mailing Address - Fax:304-755-1528
Practice Address - Street 1:119C MAIN ST
Practice Address - Street 2:
Practice Address - City:POCA
Practice Address - State:WV
Practice Address - Zip Code:25159-9602
Practice Address - Country:US
Practice Address - Phone:304-755-1500
Practice Address - Fax:304-755-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0141141000Medicaid