Provider Demographics
NPI:1922043488
Name:WEST PRESCRIPTION SHOP
Entity type:Organization
Organization Name:WEST PRESCRIPTION SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-552-6111
Mailing Address - Street 1:514 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1971
Mailing Address - Country:US
Mailing Address - Phone:478-552-6111
Mailing Address - Fax:478-552-6113
Practice Address - Street 1:514 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1971
Practice Address - Country:US
Practice Address - Phone:478-552-6111
Practice Address - Fax:478-552-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0041503336C0003X, 332BX2000X
GACF000278335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00038101AMedicaid
GA0237570002Medicare NSC