Provider Demographics
NPI:1427395391
Name:WESTFALL, DAVID THOMAS
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:WESTFALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 US 1 S STE 1
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7000
Mailing Address - Country:US
Mailing Address - Phone:904-794-1104
Mailing Address - Fax:904-794-5590
Practice Address - Street 1:4255 US 1 S STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7000
Practice Address - Country:US
Practice Address - Phone:904-794-1104
Practice Address - Fax:904-794-5590
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist