Provider Demographics
NPI:1336120914
Name:WESTSIDE DRUG INC
Entity Type:Organization
Organization Name:WESTSIDE DRUG INC
Other - Org Name:HOSPITAL DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-384-3057
Mailing Address - Street 1:308 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3530
Mailing Address - Country:US
Mailing Address - Phone:912-384-3057
Mailing Address - Fax:912-383-8428
Practice Address - Street 1:308 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3530
Practice Address - Country:US
Practice Address - Phone:912-384-3057
Practice Address - Fax:912-383-8428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE DRUG INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-09
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000135154BMedicaid
0240160003Medicare ID - Type Unspecified