Provider Demographics
NPI:1710502067
Name:WEST LAKE RX LLC
Entity Type:Organization
Organization Name:WEST LAKE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BLOCKER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:210-514-6252
Mailing Address - Street 1:1255 SW LOOP 410 STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1666
Mailing Address - Country:US
Mailing Address - Phone:210-514-6252
Mailing Address - Fax:210-645-7165
Practice Address - Street 1:1255 SW LOOP 410 STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1666
Practice Address - Country:US
Practice Address - Phone:210-514-6252
Practice Address - Fax:210-645-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy