Provider Demographics
NPI:1891009783
Name:THE WINNER PHARMACY, INC.
Entity Type:Organization
Organization Name:THE WINNER PHARMACY, INC.
Other - Org Name:THE WINNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIEBELKORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-7777
Mailing Address - Street 1:620 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-1218
Mailing Address - Country:US
Mailing Address - Phone:605-842-7777
Mailing Address - Fax:605-842-2271
Practice Address - Street 1:620 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-1218
Practice Address - Country:US
Practice Address - Phone:605-842-7777
Practice Address - Fax:605-842-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
SD100-19593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1891009783Medicaid
4354279OtherNCPDP PROVIDER IDENTIFICATION NUMBER
SD6587310001Medicare NSC