Provider Demographics
NPI:1184725350
Name:WINN DIXIE PHARMACY
Entity type:Organization
Organization Name:WINN DIXIE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-D
Authorized Official - Phone:561-637-2364
Mailing Address - Street 1:10004 WINDING LAKE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5834
Mailing Address - Country:US
Mailing Address - Phone:954-749-3518
Mailing Address - Fax:
Practice Address - Street 1:14595 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-3730
Practice Address - Country:US
Practice Address - Phone:561-637-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy