Healthcare Provider Details

I. General information

NPI: 1235174400
Provider Name (Legal Business Name): WESTLAB PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W NEWBERRY RD STE A5
GAINESVILLE FL
32607-5200
US

IV. Provider business mailing address

4410 W NEWBERRY RD STE A5
GAINESVILLE FL
32607-5200
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-8111
  • Fax: 352-373-8009
Mailing address:
  • Phone: 352-373-8111
  • Fax: 352-373-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH27985
License Number StateFL

VIII. Authorized Official

Name: PRINCE HINSON
Title or Position: OWNER AND MGR
Credential: RPH
Phone: 352-373-8111