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General NPI Number Information
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NPI Number | 1760535900
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Entity Type | Organization
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Legal Business Name | WESTPARK DISCOUNT PHARMACY
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 350 WESTPARK WAY STE 300
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City | EULESS
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State | TX
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Zip | 76040-3964
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Country | US
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Telephone | 817-545-6600
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Fax | 817-545-6667
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Provider Business Mailing Address
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Address Line | 350 WESTPARK WAY SUITE 300
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City | EULESS
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State | TX
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Zip | 76040-3964
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Country | US
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Telephone | 817-545-6600
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Fax | 817-545-6667
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. EMMANUEL O EGENTI
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Credential | RPH
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Telephone | 817-545-6600
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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 | 24259
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License Number State | TX
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