Provider Demographics
NPI:1609524024
Name:WINSLOW, JONNESSIA SHUNTA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONNESSIA
Middle Name:SHUNTA
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2703
Mailing Address - Country:US
Mailing Address - Phone:318-914-0693
Mailing Address - Fax:
Practice Address - Street 1:3304 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7308
Practice Address - Country:US
Practice Address - Phone:318-651-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist