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General NPI Number Information
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NPI Number | 1215988670
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Entity Type | Organization
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Legal Business Name | WESTSIDE PHARMACY INC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | RT 10 COOK PKWY AND LOGAN ST
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City | OCEANA
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State | WV
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Zip | 24870
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Country | US
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Telephone | 304-682-0444
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Fax | 304-682-0447
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | OCEANA
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State | WV
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Zip | 24870-0069
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Country | US
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Telephone | 304-682-0444
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Fax | 304-682-0447
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEVONNA MILLER WEST
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Credential | DRPH
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Telephone | 304-682-0444
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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 | SP0552334
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License Number State | WV
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