MEDICARE: WEST COAST HS US PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1235886391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST HS US PHARMACY LLC

Provider Business Mailing Address
First Line	:	10375 RICHMOND AVE STE 700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-4165
Country	:	US
Telephone Number	:	713-337-3016
Fax Number	:	713-337-2994

Provider Business Practice Location Address
First Line	:	3904 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3502
Country	:	US
Telephone Number	:	619-295-3109
Fax Number	:	619-295-6478

Authorized Official
Title or Position	:	VP OF PHARMACY OPERATIONS
Name	:	ZIA M GHEEWALA
Credential	:
Telephone Number	:	713-337-3016

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	09/15/2022

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