Provider Demographics
NPI:1104112671
Name:WINNERS PHARMACY INC.
Entity type:Organization
Organization Name:WINNERS PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIMDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-595-1110
Mailing Address - Street 1:17050 N US HIGHWAY 301 STE 5
Mailing Address - Street 2:
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-2515
Mailing Address - Country:US
Mailing Address - Phone:352-595-1110
Mailing Address - Fax:352-595-1120
Practice Address - Street 1:17050 N US HIGHWAY 301 STE 5
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-2515
Practice Address - Country:US
Practice Address - Phone:352-595-1110
Practice Address - Fax:352-595-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH255113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5706291OtherNCPDP PROVIDER IDENTIFICATION NUMBER