Provider Demographics
NPI:1578334751
Name:WEST END ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WEST END ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:MOONEYHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-932-4742
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:870-931-0311
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:870-931-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198278407Medicaid