Provider Demographics
NPI:1467996314
Name:WESTLAKE HEALTH & BEAUTY PRODUCTS
Entity Type:Organization
Organization Name:WESTLAKE HEALTH & BEAUTY PRODUCTS
Other - Org Name:WESTLAKE HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:817-274-8200
Mailing Address - Street 1:5421 BASSWOOD BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4483
Mailing Address - Country:US
Mailing Address - Phone:817-893-5182
Mailing Address - Fax:817-893-5236
Practice Address - Street 1:5421 BASSWOOD BLVD STE 700
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4483
Practice Address - Country:US
Practice Address - Phone:817-893-5182
Practice Address - Fax:817-893-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX313083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149586Medicaid
2167006OtherPK