Winnsboro Drug Store, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

9084 Issued in LA

Legal business name

WINNSBORO DRUG STORE, INC.

Practice address

1213 Common St
Winnsboro, LA 71295-2609

Phone

(318) 435-4311

Fax

(318) 435-3558

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jerry Breithaupt, RPH

Title

Pharmasist Owner

Phone

(318) 435-4311

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710073184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 COMMON ST",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712952609",
            "telephone_number": "318-435-4311",
            "fax_number": "318-435-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 COMMON ST",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712952609",
            "telephone_number": "318-435-4311",
            "fax_number": "318-435-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNSBORO DRUG STORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BREITHAUPT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PHARMASIST OWNER",
        "authorized_official_telephone_number": "318-435-4311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "LA",
            "license": "9084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1243272",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Winnsboro, LA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.