MEDICARE: WEST 14 PHARMACY CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	024776	NY
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215911953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST 14 PHARMACY CORP.

Provider Business Mailing Address
First Line	:	312 W 14TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	212-727-7979
Fax Number	:	212-645-5693

Provider Business Practice Location Address
First Line	:	312 W 14TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	212-727-7979
Fax Number	:	212-645-5693

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PARESHBHAI DESAI
Credential	:
Telephone Number	:	212-727-7979

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/06/2021

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