Provider Demographics
NPI:1164575403
Name:WESTGATE PHARMACY RX LLC
Entity Type:Organization
Organization Name:WESTGATE PHARMACY RX LLC
Other - Org Name:WESTGATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-370-2500
Mailing Address - Street 1:112 HILLSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3148
Mailing Address - Country:US
Mailing Address - Phone:732-370-2500
Mailing Address - Fax:732-256-2099
Practice Address - Street 1:112 HILLSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3148
Practice Address - Country:US
Practice Address - Phone:732-370-2500
Practice Address - Fax:732-230-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006709003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158216OtherPK
NJ6016910001Medicare NSC
NJ0223441Medicaid