Provider Demographics
NPI:1982701819
Name:MED WIN INC
Entity Type:Organization
Organization Name:MED WIN INC
Other - Org Name:WINCHESTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-729-1940
Mailing Address - Street 1:568 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1953
Mailing Address - Country:US
Mailing Address - Phone:781-729-1940
Mailing Address - Fax:781-729-3460
Practice Address - Street 1:568 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1953
Practice Address - Country:US
Practice Address - Phone:781-729-1940
Practice Address - Fax:781-729-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
MA11073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2215083OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA0431613Medicaid