Healthcare Provider Details

I. General information

NPI: 1902214893
Provider Name (Legal Business Name): MICHAEL WESTLAKE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 MANZANITA AVE
CARMICHAEL CA
95608-1724
US

IV. Provider business mailing address

640 E MAIN ST STE 2
GRASS VALLEY CA
95945-5854
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-4930
  • Fax:
Mailing address:
  • Phone: 530-274-0100
  • Fax: 530-274-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number68277
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 68277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: