Healthcare Provider Details

I. General information

NPI: 1376659458
Provider Name (Legal Business Name): WEST PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 ELECTRIC RD
ROANOKE VA
24018-1938
US

IV. Provider business mailing address

2012 ELECTRIC RD
ROANOKE VA
24018-1938
US

V. Phone/Fax

Practice location:
  • Phone: 540-774-5500
  • Fax: 540-774-7080
Mailing address:
  • Phone: 540-774-5500
  • Fax: 540-774-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003941
License Number StateVA

VIII. Authorized Official

Name: MR. CHARLES MITCHELL WEST II
Title or Position: OWNER
Credential: R.PH.
Phone: 540-774-5500