1205930252 NPI number — WESTCHESTER PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205930252 NPI number — WESTCHESTER PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTCHESTER PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205930252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8930 S SEPULVEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-670-3463
Provider Business Mailing Address Fax Number:
310-670-4038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8930 S SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-670-3463
Provider Business Practice Location Address Fax Number:
310-670-4038
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTEN
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PIC/AO
Authorized Official Telephone Number:
310-670-3463

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY55569 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1997522 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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