Provider Demographics
NPI:1659104651
Name:WINEGARDNER INC
Entity type:Organization
Organization Name:WINEGARDNER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-275-9640
Mailing Address - Street 1:4151 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1414
Mailing Address - Country:US
Mailing Address - Phone:405-913-6227
Mailing Address - Fax:405-617-7025
Practice Address - Street 1:4151 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1414
Practice Address - Country:US
Practice Address - Phone:405-913-6227
Practice Address - Fax:405-617-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy