Provider Demographics
NPI:1437373438
Name:WESTFIELD PHARMACY INC
Entity Type:Organization
Organization Name:WESTFIELD PHARMACY INC
Other - Org Name:WESTFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:P
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, RP
Authorized Official - Phone:308-534-1147
Mailing Address - Street 1:1845 WEST A STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4534
Mailing Address - Country:US
Mailing Address - Phone:308-532-5539
Mailing Address - Fax:308-532-3784
Practice Address - Street 1:1845 WEST A STREET
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4534
Practice Address - Country:US
Practice Address - Phone:308-534-1147
Practice Address - Fax:308-532-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01-5763657332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid
0420840001Medicare PIN