Provider Demographics
NPI:1639434103
Name:WESTGATE FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:WESTGATE FAMILY PHARMACY INC
Other - Org Name:WESTGATE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJWA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-531-0000
Mailing Address - Street 1:3147 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2923
Mailing Address - Country:US
Mailing Address - Phone:419-531-0000
Mailing Address - Fax:419-535-0007
Practice Address - Street 1:3147 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2923
Practice Address - Country:US
Practice Address - Phone:419-470-0700
Practice Address - Fax:419-535-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0222358503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070758Medicaid
2136333OtherPK