Provider Demographics
NPI:1619046711
Name:THOMAS E. WINNINGHAM
Entity Type:Organization
Organization Name:THOMAS E. WINNINGHAM
Other - Org Name:WINNINGHAM DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-344-2763
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:232 W MAIN ST
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-0130
Mailing Address - Country:US
Mailing Address - Phone:501-344-2763
Mailing Address - Fax:501-344-8383
Practice Address - Street 1:232 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:AR
Practice Address - Zip Code:72020-0130
Practice Address - Country:US
Practice Address - Phone:501-344-2763
Practice Address - Fax:501-344-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR01834332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100499407Medicaid
AR118686716OtherMEDICAID DME
AR100499407Medicaid