Basic Information
| Provider Information | |||||||||
| NPI: | 1811226459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINKE | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69004 | ||||||||
| Address2: | PHARMACY DEPT (119) | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713069004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | 3184835013 | ||||||||
| Practice Location | |||||||||
| Address1: | 2495 SHREVEPORT HWY # 71 | ||||||||
| Address2: | PHARMACY DEPT (119) | ||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713604044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | 3184835013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 017210 | LA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.