Provider Demographics
NPI:1316240708
Name:WINIESDORFFER, LUKE EDWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:EDWARD
Last Name:WINIESDORFFER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1213
Mailing Address - Country:US
Mailing Address - Phone:304-733-3373
Mailing Address - Fax:
Practice Address - Street 1:6360 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1213
Practice Address - Country:US
Practice Address - Phone:304-733-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist