Provider Demographics
NPI:1225592058
Name:WEST LANE CLINIC RX LLC
Entity Type:Organization
Organization Name:WEST LANE CLINIC RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOUCH
Authorized Official - Middle Name:
Authorized Official - Last Name:UC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-463-4325
Mailing Address - Street 1:4873 WEST LN STE B
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-4548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4873 WEST LN STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4548
Practice Address - Country:US
Practice Address - Phone:209-463-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy