Healthcare Provider Details

I. General information

NPI: 1487672390
Provider Name (Legal Business Name): WESTFIELD PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S UNION ST
WESTFIELD IN
46074-9458
US

IV. Provider business mailing address

103 S UNION ST
WESTFIELD IN
46074-9458
US

V. Phone/Fax

Practice location:
  • Phone: 317-896-9378
  • Fax: 317-896-2731
Mailing address:
  • Phone: 317-896-9378
  • Fax: 317-896-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60002780A
License Number StateIN

VIII. Authorized Official

Name: DAVID L WEISS
Title or Position: PRESIDENT
Credential:
Phone: 317-896-9378