MEDICARE: WESTSIDE 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336C0003X	Community/Retail Pharmacy	PH24518	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1054319	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1558685776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE PHARMACY LLC

Provider Business Mailing Address
First Line	:	2977 W COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3502
Country	:	US
Telephone Number	:	954-484-8474
Fax Number	:	954-484-8475

Provider Business Practice Location Address
First Line	:	2977 W COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3502
Country	:	US
Telephone Number	:	954-484-8474
Fax Number	:	954-484-8475

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	BHARATKUMAR PATEL
Credential	:
Telephone Number	:	954-785-7747

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	08/29/2011

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Directions to “WESTSIDE PHARMACY LLC ” Practice Location

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