MEDICARE: WEST PRESCRIPTION SHOP

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	3336C0003X	Community/Retail Pharmacy	PHRE004150	GA
2	335E00000X	Prosthetic/Orthotic Supplier	CF000278	GA
3	332BX2000X	Oxygen Equipment & Supplies (DME)	PHRE004150	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922043488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PRESCRIPTION SHOP

Provider Business Mailing Address
First Line	:	514 WASHINGTON AVE
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1971
Country	:	US
Telephone Number	:	478-552-6111
Fax Number	:	478-552-6113

Provider Business Practice Location Address
First Line	:	514 WASHINGTON AVE
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1971
Country	:	US
Telephone Number	:	478-552-6111
Fax Number	:	478-552-6113

Authorized Official
Title or Position	:	OWNER/CHIEF PHARMACIST
Name	:	MR. LEWIS M. WEST JR.
Credential	:	RPH
Telephone Number	:	478-552-6111

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	05/08/2020

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Directions to “WEST PRESCRIPTION SHOP ” Practice Location

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