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General NPI Number Information
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NPI Number | 1144375015
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Entity Type | Organization
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Legal Business Name | WESTSIDE DRUGS INC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 308 WESTSIDE DR
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City | DOUGLAS
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State | GA
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Zip | 31533-3530
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Country | US
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Telephone | 912-384-0693
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Fax | 912-383-8428
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Provider Business Mailing Address
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Address Line | 308 WESTSIDE DR
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City | DOUGLAS
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State | GA
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Zip | 31533-3530
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Country | US
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Telephone | 912-384-0693
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Fax | 912-383-8428
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Authorized Official
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Title or Position | OWNER
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Name | JIMMY CARTER
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Credential | RPH
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Telephone | 912-384-0693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE005434
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License Number State | GA
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