Provider Demographics
NPI:1851449581
Name:WINSTEAD, FRED SMITH JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:SMITH
Last Name:WINSTEAD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 VARDRY ST.
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3331
Mailing Address - Country:US
Mailing Address - Phone:864-271-4932
Mailing Address - Fax:864-233-6064
Practice Address - Street 1:413 VARDRY ST. CORNER DRUGS INC.
Practice Address - Street 2:SUITE 1-B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3331
Practice Address - Country:US
Practice Address - Phone:864-271-4932
Practice Address - Fax:864-233-6064
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC724192Medicaid
SC027064-0001Medicare ID - Type Unspecified