MEDICARE: WESTCLIFF PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157694	OTHER		PK

General Provider Information

NPI Number	:	1356713390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCLIFF PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91610-0240
Country	:	US
Telephone Number	:	212-350-3800
Fax Number	:	212-350-3838

Provider Business Practice Location Address
First Line	:	896 1ST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-8008
Country	:	US
Telephone Number	:	212-350-3800
Fax Number	:	212-350-3838

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	ARIS SISLYAN
Credential	:
Telephone Number	:	212-350-3800

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	08/18/2016

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