Provider Demographics
NPI:1427652122
Name:WYNTER, CONRAD H JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:H
Last Name:WYNTER
Suffix:JR
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 1:3110 SPICY CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7161
Mailing Address - Country:US
Mailing Address - Phone:917-402-4574
Mailing Address - Fax:
Practice Address - Street 1:8139 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3142
Practice Address - Country:US
Practice Address - Phone:917-402-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist