Provider Demographics
NPI:1437578697
Name:WEST END ASSOCIATES, INCORPORATED
Entity Type:Organization
Organization Name:WEST END ASSOCIATES, INCORPORATED
Other - Org Name:SOO'S WEST END PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:STORM
Authorized Official - Last Name:SOO
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-932-6930
Mailing Address - Street 1:619 W NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3970
Mailing Address - Country:US
Mailing Address - Phone:870-932-4742
Mailing Address - Fax:870-932-0311
Practice Address - Street 1:619 W NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3970
Practice Address - Country:US
Practice Address - Phone:870-932-4742
Practice Address - Fax:870-932-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198278407Medicaid