Provider Demographics
NPI:1013337591
Name:WINTER PARK DISCOUNT DRUG NILKANTH INC.
Entity Type:Organization
Organization Name:WINTER PARK DISCOUNT DRUG NILKANTH INC.
Other - Org Name:WINTER PARK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:URMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-667-3791
Mailing Address - Street 1:5220 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7056
Mailing Address - Country:US
Mailing Address - Phone:910-791-2346
Mailing Address - Fax:910-791-3348
Practice Address - Street 1:5220 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7056
Practice Address - Country:US
Practice Address - Phone:910-791-2346
Practice Address - Fax:910-791-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702317Medicaid
NC0656033Medicaid
3403071OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0656033Medicaid
NC7702317Medicaid