Provider Demographics
NPI:1881933307
Name:WINGERTER, ALAN EDWARD (PH)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:EDWARD
Last Name:WINGERTER
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3876
Mailing Address - Country:US
Mailing Address - Phone:386-325-5505
Mailing Address - Fax:
Practice Address - Street 1:6400 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3876
Practice Address - Country:US
Practice Address - Phone:386-325-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist