Provider Demographics
NPI:1952494395
Name:WINN ENTERPRISES PHARMACY CONSULTING DIVISION INC
Entity Type:Organization
Organization Name:WINN ENTERPRISES PHARMACY CONSULTING DIVISION INC
Other - Org Name:WINN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-442-4527
Mailing Address - Street 1:149 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-2650
Mailing Address - Country:US
Mailing Address - Phone:601-442-4527
Mailing Address - Fax:601-442-4490
Practice Address - Street 1:149 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-2650
Practice Address - Country:US
Practice Address - Phone:601-442-4527
Practice Address - Fax:601-442-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS041490113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2519330OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MS1269387Medicaid
MS0330390Medicaid
MS0330390Medicaid