Provider Demographics
NPI:1710477245
Name:WESTMINSTER SENIOR CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:WESTMINSTER SENIOR CARE PHARMACY, LLC
Other - Org Name:WESTMINSTER PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:BASILE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-244-9280
Mailing Address - Street 1:7703 KINGSPOINTE PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8583
Mailing Address - Country:US
Mailing Address - Phone:407-244-9280
Mailing Address - Fax:877-244-9272
Practice Address - Street 1:1700 3RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5946
Practice Address - Country:US
Practice Address - Phone:941-684-3671
Practice Address - Fax:877-244-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
FLPH307003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2172714OtherPK