Provider Demographics
NPI:1851706063
Name:BIRD, WINIFRED PATRICIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:PATRICIA
Last Name:BIRD
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 1:275 PAOLI RD
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30627-1256
Mailing Address - Country:US
Mailing Address - Phone:706-498-3208
Mailing Address - Fax:
Practice Address - Street 1:955 ELBERT ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2641
Practice Address - Country:US
Practice Address - Phone:706-283-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011371183500000X
GA011371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist