Individual provider Active NPI

Craig A Winder

  • Pharmacist
  • Davenport, IA
National Provider Identifier
1366569501
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
16833 Issued in IA
Practice address
2200 W Kimberly Rd
Davenport, IA 52806-5300
Phone
(563) 391-1543
Fax
(563) 391-9117
NPI assigned
Mar 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 16833 IA Primary
Pharmacist 183500000X 8272 WI

Addresses

Primary practice location

2200 W Kimberly Rd
Davenport, IA 52806-5300

Mailing address

4136 Kelling CT
Davenport, IA 52806-4800
Phone (563) 391-2688

Other identifiers 1

IdentifierTypeStateIssuer
0047746MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
16833IAMDPharmacist
8272WIMDNurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366569501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4136 KELLING CT",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528064800",
            "telephone_number": "563-391-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528065300",
            "telephone_number": "563-391-1543",
            "fax_number": "563-391-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINDER",
        "first_name": "CRAIG",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "16833",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "8272",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047746",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.