Provider Demographics
NPI:1740372200
Name:WINSLOW DRUG
Entity type:Organization
Organization Name:WINSLOW DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-842-2652
Mailing Address - Street 1:290 WINSLOW WAY E
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-842-2652
Mailing Address - Fax:206-780-0829
Practice Address - Street 1:290 WINSLOW WAY E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-2652
Practice Address - Fax:206-780-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00000944333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6099501Medicaid
WA6099501Medicaid