Provider Demographics
NPI:1205819968
Name:WINEGARS SUPER MARKETS INC
Entity type:Organization
Organization Name:WINEGARS SUPER MARKETS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-298-5407
Mailing Address - Street 1:574 W 3400 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8036
Mailing Address - Country:US
Mailing Address - Phone:801-298-5407
Mailing Address - Fax:801-298-5463
Practice Address - Street 1:1080 W 300 N
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-8732
Practice Address - Country:US
Practice Address - Phone:801-773-7330
Practice Address - Fax:801-525-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-26
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9423319-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154481OtherPK