Provider Demographics
NPI:1770009094
Name:WINK, DONNA SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SUSAN
Last Name:WINK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 NIGHTINGALE ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2751
Mailing Address - Country:US
Mailing Address - Phone:732-322-7936
Mailing Address - Fax:
Practice Address - Street 1:3 NIGHTINGALE ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2751
Practice Address - Country:US
Practice Address - Phone:732-322-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01752200183500000X
NJ28RIO1752200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist