Healthcare Provider Details

I. General information

NPI: 1275831711
Provider Name (Legal Business Name): WEST GENERAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 W FLAGLER ST STE-104
MIAMI FL
33130-1248
US

IV. Provider business mailing address

752 W FLAGLER ST STE-104
MIAMI FL
33130-1248
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-2841
  • Fax: 305-403-2844
Mailing address:
  • Phone: 305-403-2841
  • Fax: 305-403-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25258
License Number StateFL

VIII. Authorized Official

Name: ORLANDO FERNANDEZ BACALLAO
Title or Position: PRESIDENT
Credential:
Phone: 305-403-2841