Provider Demographics
NPI:1841774320
Name:WINSKO, ANGELA ANN MCDANIEL
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANN MCDANIEL
Last Name:WINSKO
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 1:1180 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4137
Mailing Address - Country:US
Mailing Address - Phone:409-767-0148
Mailing Address - Fax:
Practice Address - Street 1:1421 S. BEGLIS PKWY
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5603
Practice Address - Country:US
Practice Address - Phone:337-528-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022688208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.022688OtherLOUISIANA BOARD OF PHARMACY
TX40449OtherTEXAS BOARD OF PHARMACY
LA2479539Medicaid
LA004436OtherMEDICATION ADMINISTRATION REGISTRATION LA. BOARD OF PHARMACY