Healthcare Provider Details

I. General information

NPI: 1386761757
Provider Name (Legal Business Name): WESTSIDE FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 W SUNSET AVE
SPRINGDALE AR
72762-4959
US

IV. Provider business mailing address

3819 W SUNSET AVE
SPRINGDALE AR
72762-4959
US

V. Phone/Fax

Practice location:
  • Phone: 479-756-3232
  • Fax: 479-756-1217
Mailing address:
  • Phone: 479-756-3232
  • Fax: 479-756-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20556
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN RAGAN
Title or Position: OWNER, PIC
Credential: PHRM
Phone: 479-756-3232