Provider Demographics
NPI:1235174400
Name:WESTLAB PHARMACY INC
Entity Type:Organization
Organization Name:WESTLAB PHARMACY INC
Other - Org Name:WESTLAB PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MGR
Authorized Official - Prefix:
Authorized Official - First Name:PRINCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-373-8111
Mailing Address - Street 1:4410 W NEWBERRY RD
Mailing Address - Street 2:STE A5
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5200
Mailing Address - Country:US
Mailing Address - Phone:352-373-8111
Mailing Address - Fax:352-373-8009
Practice Address - Street 1:4410 W NEWBERRY RD
Practice Address - Street 2:STE A5
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5200
Practice Address - Country:US
Practice Address - Phone:352-373-8111
Practice Address - Fax:352-373-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
FLPH279853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101695400Medicaid
2011298OtherPK
0488990002Medicare NSC