Provider Demographics
NPI:1649331265
Name:WINSLETTE PHARMACY INC
Entity type:Organization
Organization Name:WINSLETTE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOOTSON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WINSLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-290-0300
Mailing Address - Street 1:2444 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1959
Mailing Address - Country:US
Mailing Address - Phone:706-290-0300
Mailing Address - Fax:706-290-0370
Practice Address - Street 1:2444 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1959
Practice Address - Country:US
Practice Address - Phone:706-290-0300
Practice Address - Fax:706-290-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336H0001X, 332BP3500X, 333600000X
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00713512AMedicaid
AL105073OtherMEDICAID DME
GA1142974OtherNABP NCPDP
AL105171OtherMEDICAID PHARMACY
GA00713512AMedicaid
1131210001Medicare NSC