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General NPI Number Information
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NPI Number | 1194162545
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Entity Type | Organization
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Legal Business Name | WESTPARK DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 5017 HERITAGE AVE STE CON1
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City | COLLEYVILLE
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State | TX
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Zip | 76034-5994
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Country | US
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Telephone | 817-571-9100
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Fax | 817-571-9131
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Provider Business Mailing Address
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Address Line | 6913 BERNADINE DR
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City | WATAUGA
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State | TX
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Zip | 76148-2165
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Country | US
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Telephone | 817-571-9100
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Fax | 817-571-9131
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Authorized Official
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Title or Position | PRESIDENT /CEO
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Name | EMMANUEL EGENTI
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Credential |
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Telephone | 817-571-9100
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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 | 28568
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License Number State | TX
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