West Side Drug Co a Corp
Organization Active NPI Community/Retail Pharmacy · Firebaugh, CA
NPI 1780795377 · NPPES record last updated Jun 3, 2015
Key facts
- NPI
- 1780795377
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY10636 (CA)
- Legal business name
- WEST SIDE DRUG CO A CORP
- Practice address
- 1101 O St
Firebaugh, CA 93622-2224 - Phone
- (559) 659-2159
- Fax
- (559) 659-2985
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeff Louie
- Title
- Tres
- Phone
- (559) 659-2159
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 1
-
Ronald Leonard Louie, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930052726 | CA | DME Supplier - Pharmacy | 5496874638 | Practice locations: Firebaugh, CA |
National Provider Directory
- Tax ID family
- West Side Drug Co
Locations
1101 O St
Firebaugh, CA 93622
Phone (559) 659-2159
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY10636 | CA | Yes |
Addresses
Primary practice location
1101 O St
Firebaugh, CA 93622-2224
Mailing address
1101 O St
Firebaugh, CA 93622-2224
Phone (559) 659-2159
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780795377 | Medicaid | CA | |
| PHA106360 | Medicaid | CA |
Other providers in Firebaugh, CA
- United Health Centers of the San Joaquin Valley
- Annalisia Valdez
- Valley Health Team, Inc.
- Valley Health Team, Inc.
- West Side Drug Co a Corp
- Westside Medical Group Inc
- Westside Medical Group Inc
All providers in Firebaugh, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.