Provider Demographics
NPI:1629129457
Name:WINTERS, ROY EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:EUGENE
Last Name:WINTERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14524 HIGHWAY 67 N
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63967-8247
Mailing Address - Country:US
Mailing Address - Phone:573-998-2455
Mailing Address - Fax:
Practice Address - Street 1:#1HALS PLAZA
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957
Practice Address - Country:US
Practice Address - Phone:573-223-4823
Practice Address - Fax:573-223-2665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist