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General NPI Number Information
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NPI Number | 1164575403
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Entity Type | Organization
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Legal Business Name | WESTGATE PHARMACY RX LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 112 HILLSIDE BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3148
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Country | US
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Telephone | 732-370-2500
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Fax | 732-230-6939
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Provider Business Mailing Address
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Address Line | 112 HILLSIDE BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3148
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Country | US
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Telephone | 732-370-2500
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Fax | 732-256-2099
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Authorized Official
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Title or Position | MANG
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Name | DAVID SEGAL
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Credential |
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Telephone | 732-370-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00670900
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License Number State | NJ
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