Provider Demographics
NPI:1639421001
Name:WINTER, VICKI ANDREA
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:ANDREA
Last Name:WINTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:PINEHILL
Mailing Address - State:NM
Mailing Address - Zip Code:87357-0310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BIA ROUTE 140
Practice Address - Street 2:
Practice Address - City:PINEHILL
Practice Address - State:NM
Practice Address - Zip Code:87357
Practice Address - Country:US
Practice Address - Phone:505-775-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist