MEDICARE: WESTSIDE FAMILY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1760242895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	601 BUTTERNUT ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13208-2737
Country	:	US
Telephone Number	:	315-928-6333
Fax Number	:	315-373-0080

Provider Business Practice Location Address
First Line	:	601 BUTTERNUT ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13208-2737
Country	:	US
Telephone Number	:	315-928-6333
Fax Number	:	315-373-0080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRAVEEN KUMAR CHALLA
Credential	:
Telephone Number	:	315-928-6333

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	05/10/2026

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Directions to “WESTSIDE FAMILY PHARMACY LLC ” Practice Location

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