Provider Demographics
NPI:1205144482
Name:WINN, MICHAEL LOUIS SR (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:WINN
Suffix:SR
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 1:149 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-2650
Mailing Address - Country:US
Mailing Address - Phone:601-442-4527
Mailing Address - Fax:601-442-4490
Practice Address - Street 1:149 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-2650
Practice Address - Country:US
Practice Address - Phone:601-442-4527
Practice Address - Fax:601-442-4490
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-7821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330390Medicaid