Provider Demographics
NPI:1477618809
Name:WESTGATE DRUGS INC
Entity Type:Organization
Organization Name:WESTGATE DRUGS INC
Other - Org Name:WESTGATE DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-627-7857
Mailing Address - Street 1:1015 LEE DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-3698
Mailing Address - Country:US
Mailing Address - Phone:662-627-7857
Mailing Address - Fax:662-627-7225
Practice Address - Street 1:1015 LEE DR
Practice Address - Street 2:SUITE 11
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-3698
Practice Address - Country:US
Practice Address - Phone:662-627-7857
Practice Address - Fax:662-627-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS00415/1.13336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00035351Medicaid
2050540OtherPK