Provider Demographics
NPI:1699802082
Name:WINONA BLDG. PHARMACY, INC.
Entity type:Organization
Organization Name:WINONA BLDG. PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAM
Authorized Official - Middle Name:Q
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-590-0829
Mailing Address - Street 1:PO BOX 88247
Mailing Address - Street 2:3266 N. MERIDIAN ST., #106
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-0247
Mailing Address - Country:US
Mailing Address - Phone:317-924-5551
Mailing Address - Fax:317-924-5573
Practice Address - Street 1:3266 N MERIDIAN ST STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5839
Practice Address - Country:US
Practice Address - Phone:317-924-5551
Practice Address - Fax:317-924-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN600077483336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1531816OtherNAPB #