Provider Demographics
NPI:1003202516
Name:WEST PACIFIC PHARMACY INC
Entity Type:Organization
Organization Name:WEST PACIFIC PHARMACY INC
Other - Org Name:WEST PACIFIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:FATHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-374-1777
Mailing Address - Street 1:505 W PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2568
Mailing Address - Country:US
Mailing Address - Phone:949-374-1777
Mailing Address - Fax:
Practice Address - Street 1:505 WEST PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744
Practice Address - Country:US
Practice Address - Phone:949-374-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY51628333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy