Provider Demographics
NPI:1487798195
Name:MICHAEL WEST
Entity type:Organization
Organization Name:MICHAEL WEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-839-7005
Mailing Address - Street 1:201 N ELMORE ST STE F
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-1260
Mailing Address - Country:US
Mailing Address - Phone:931-839-7005
Mailing Address - Fax:931-839-7507
Practice Address - Street 1:201 N ELMORE ST STE F
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-1260
Practice Address - Country:US
Practice Address - Phone:931-839-7005
Practice Address - Fax:931-839-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN31723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4430790Medicaid
4430790OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN4290260001Medicare NSC