MEDICARE: WEST LAKE 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	PH25247	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2130063	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841599644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAKE PHARMACY INC

Provider Business Mailing Address
First Line	:	2544 SIMPSON RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4637
Country	:	US
Telephone Number	:	407-344-4555
Fax Number	:	407-344-4566

Provider Business Practice Location Address
First Line	:	2544 SIMPSON RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4637
Country	:	US
Telephone Number	:	407-344-4555
Fax Number	:	407-344-4566

Authorized Official
Title or Position	:	MANAGER
Name	:	NAPOLEON ONYECHI
Credential	:
Telephone Number	:	407-344-4555

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	08/20/2015

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Directions to “WEST LAKE PHARMACY INC ” Practice Location

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