Provider Demographics
NPI:1275625881
Name:WEST GROUP PHARMACEUTICAL CORP
Entity Type:Organization
Organization Name:WEST GROUP PHARMACEUTICAL CORP
Other - Org Name:PROCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAU
Authorized Official - Middle Name:NGOC THANH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-899-1111
Mailing Address - Street 1:9191 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2751
Mailing Address - Country:US
Mailing Address - Phone:714-899-1111
Mailing Address - Fax:800-561-3146
Practice Address - Street 1:9191 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-899-1111
Practice Address - Fax:714-890-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA471250Medicaid
CA0557631OtherNCPDP