Provider Demographics
NPI:1790010098
Name:WINSLOW RX
Entity Type:Organization
Organization Name:WINSLOW RX
Other - Org Name:WINSLOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-453-4411
Mailing Address - Street 1:20 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-872-7979
Mailing Address - Fax:207-872-7922
Practice Address - Street 1:20 GARLAND RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-0600
Practice Address - Country:US
Practice Address - Phone:207-872-7979
Practice Address - Fax:207-453-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPH500013783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2008438OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2008438OtherNCPDP PROVIDER IDENTIFICATION NUMBER