MEDICARE: WESTERN DRUG 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	Y003477	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1997484	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780786186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 517
Second Line	:
City	:	SAINT JOHNS
State	:	AZ
Zip	:	85936-0517
Country	:	US
Telephone Number	:	928-337-2229
Fax Number	:	928-337-2500

Provider Business Practice Location Address
First Line	:	1155 W CLEVELAND
Second Line	:
City	:	ST JOHNS
State	:	AZ
Zip	:	85936
Country	:	US
Telephone Number	:	928-337-2229
Fax Number	:	928-337-2500

Authorized Official
Title or Position	:	OWNER
Name	:	FRED HARPER
Credential	:	RPH
Telephone Number	:	928-333-2916

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	06/13/2016

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Directions to “WESTERN DRUG INC ” Practice Location

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