Provider Demographics
NPI:1710002092
Name:WINOKUR, TERRY PHILLIP
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:PHILLIP
Last Name:WINOKUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 COLOMERA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8244
Mailing Address - Country:US
Mailing Address - Phone:561-395-8688
Mailing Address - Fax:561-395-7786
Practice Address - Street 1:WINN DIXIE 0259
Practice Address - Street 2:1620 S. FEDERAL HIGHWAY
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8244
Practice Address - Country:US
Practice Address - Phone:561-736-4456
Practice Address - Fax:561-395-7786
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist