Provider Demographics
NPI:1669586640
Name:PHARMACY SERVICES OF WINNFIELD INCORPORATED
Entity type:Organization
Organization Name:PHARMACY SERVICES OF WINNFIELD INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DP
Authorized Official - Phone:318-628-3575
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-1437
Mailing Address - Country:US
Mailing Address - Phone:318-628-2905
Mailing Address - Fax:318-628-3576
Practice Address - Street 1:100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3239
Practice Address - Country:US
Practice Address - Phone:318-628-3575
Practice Address - Fax:318-628-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
LAPHY.005357IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271900Medicaid
2032655OtherPK
0478940001Medicare NSC