Healthcare Provider Details

I. General information

NPI: 1861717068
Provider Name (Legal Business Name): WEST END RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 WEST AVE
CARTERSVILLE GA
30120-6100
US

IV. Provider business mailing address

824 WEST AVE
CARTERSVILLE GA
30120-6100
US

V. Phone/Fax

Practice location:
  • Phone: 770-606-0697
  • Fax: 770-606-0695
Mailing address:
  • Phone: 770-606-0697
  • Fax: 770-606-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009636
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BHAVIN PATEL
Title or Position: OWNER
Credential:
Phone: 770-606-0697