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General NPI Number Information
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NPI Number | 1922043488
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Entity Type | Organization
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Legal Business Name | WEST PRESCRIPTION SHOP
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 514 WASHINGTON AVE
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1971
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Country | US
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Telephone | 478-552-6111
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Fax | 478-552-6113
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Provider Business Mailing Address
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Address Line | 514 WASHINGTON AVE
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1971
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Country | US
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Telephone | 478-552-6111
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Fax | 478-552-6113
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Authorized Official
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Title or Position | OWNER/CHIEF PHARMACIST
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Name | MR. LEWIS M. WEST JR.
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Credential | RPH
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Telephone | 478-552-6111
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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 | PHRE004150
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CF000278
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | PHRE004150
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License Number State | GA
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