Provider Demographics
NPI:1376659458
Name:WEST PHARMACY, LLC
Entity Type:Organization
Organization Name:WEST PHARMACY, LLC
Other - Org Name:WEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WEST
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-774-5500
Mailing Address - Street 1:2012 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1938
Mailing Address - Country:US
Mailing Address - Phone:540-774-5500
Mailing Address - Fax:540-774-7080
Practice Address - Street 1:2012 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1938
Practice Address - Country:US
Practice Address - Phone:540-774-5500
Practice Address - Fax:540-774-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010039413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4837829OtherNCPDP NUMBER
VA4946130001Medicare ID - Type Unspecified