Organization
WINNSBORO DRUG STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY BREITHAUPT RPH (PHARMASIST OWNER)
(318) 435-4311
Entity
Organization
Contact information
Practice address
1213 COMMON ST, WINNSBORO, LA 71295-2609
(318) 435-4311
(318) 435-3558
Mailing address
1213 COMMON ST, WINNSBORO, LA 71295-2609
(318) 435-4311
(318) 435-3558
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9084
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1243272
—
LA
Enumeration date
10/05/2006
Last updated
08/22/2020
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