Healthcare Provider Details

I. General information

NPI: 1922043488
Provider Name (Legal Business Name): WEST PRESCRIPTION SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 WASHINGTON AVE
SANDERSVILLE GA
31082-1971
US

IV. Provider business mailing address

514 WASHINGTON AVE
SANDERSVILLE GA
31082-1971
US

V. Phone/Fax

Practice location:
  • Phone: 478-552-6111
  • Fax: 478-552-6113
Mailing address:
  • Phone: 478-552-6111
  • Fax: 478-552-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHRE004150
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE004150
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCF000278
License Number StateGA

VIII. Authorized Official

Name: MR. LEWIS M. WEST JR.
Title or Position: OWNER/CHIEF PHARMACIST
Credential: RPH
Phone: 478-552-6111