NPIMap

Organization Active NPI

West Side Pharmacy, Inc.

  • Family Medicine Physician
  • Benton, AR
National Provider Identifier
1366060576
Registry record updated Oct 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WEST SIDE PHARMACY, INC.
Practice address
620 W South St
Benton, AR 72015-4258
Phone
(501) 778-3151
Fax
(501) 778-7329
NPI assigned
Jul 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Blake Torres
Title
Owner
Phone
(501) 778-3151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

620 W South St
Benton, AR 72015-4258

Mailing address

620 W South St
Benton, AR 72015-4258
Phone (501) 778-3151

Other names 1

  • West Side Clinical Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Westside Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

620 W South St
Benton, AR 72015
Phone (501) 778-3151

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1366060576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W SOUTH ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154258",
            "telephone_number": "501-778-3151",
            "fax_number": "501-778-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W SOUTH ST",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154258",
            "telephone_number": "501-778-3151",
            "fax_number": "501-778-7329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SIDE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "TORRES",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-778-3151"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Side Clinical Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Side Clinical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.