Healthcare Provider Details

I. General information

NPI: 1851470413
Provider Name (Legal Business Name): WESTBY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W STATE ST
WESTBY WI
54667-1255
US

IV. Provider business mailing address

104 W STATE ST
WESTBY WI
54667-1255
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-3995
  • Fax: 608-634-4553
Mailing address:
  • Phone: 608-634-3995
  • Fax: 608-634-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY W MILLER
Title or Position: PHARMACIST
Credential:
Phone: 608-634-3995