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General NPI Number Information
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NPI Number | 1992274831
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Entity Type | Organization
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Legal Business Name | WESTSIDE FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 601 BUTTERNUT ST
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City | SYRACUSE
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State | NY
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Zip | 13208-2737
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Country | US
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Telephone | 315-928-6333
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Fax | 315-373-0080
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Provider Business Mailing Address
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Address Line | 601 BUTTERNUT ST
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City | SYRACUSE
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State | NY
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Zip | 13208-2737
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Country | US
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Telephone | 315-928-6333
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Fax | 315-373-0080
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. MALLIKA KOPALLE
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Credential |
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Telephone | 315-928-6333
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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 |
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License Number State |
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