Provider Demographics
NPI:1902524515
Name:TINUBU, WINSTON
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:
Last Name:TINUBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 170TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5510
Mailing Address - Country:US
Mailing Address - Phone:305-758-1984
Mailing Address - Fax:855-562-6970
Practice Address - Street 1:100 NW 170TH ST STE 208
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5510
Practice Address - Country:US
Practice Address - Phone:305-758-1984
Practice Address - Fax:855-562-6970
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist