Provider Demographics
NPI:1285045732
Name:WESTERN PHARMACY CORP
Entity Type:Organization
Organization Name:WESTERN PHARMACY CORP
Other - Org Name:WESTERN PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUVALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-469-7756
Mailing Address - Street 1:1609 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1827
Mailing Address - Country:US
Mailing Address - Phone:786-536-7847
Mailing Address - Fax:786-536-7675
Practice Address - Street 1:1609 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1827
Practice Address - Country:US
Practice Address - Phone:786-536-7847
Practice Address - Fax:786-536-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-17
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH282313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146271OtherPK