Provider Demographics
NPI:1447302948
Name:WINCHESTER PHARMACY, INC.
Entity type:Organization
Organization Name:WINCHESTER PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-695-0010
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-0217
Mailing Address - Country:US
Mailing Address - Phone:937-695-0010
Mailing Address - Fax:937-695-0015
Practice Address - Street 1:19223 SR 136
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-0217
Practice Address - Country:US
Practice Address - Phone:937-695-0010
Practice Address - Fax:937-695-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175920Medicaid
OH0175920Medicaid