Provider Demographics
NPI:1760535900
Name:WESTPARK DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:WESTPARK DISCOUNT PHARMACY
Other - Org Name:WESTPARK DISCOUNT PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-545-6600
Mailing Address - Street 1:350 WESTPARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3964
Mailing Address - Country:US
Mailing Address - Phone:817-545-6600
Mailing Address - Fax:817-545-6667
Practice Address - Street 1:350 WESTPARK WAY
Practice Address - Street 2:STE 300
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3964
Practice Address - Country:US
Practice Address - Phone:817-545-6600
Practice Address - Fax:817-545-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242593336C0003X, 1835G0303X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Multi-Specialty
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145567Medicaid
TX5741190001Medicare ID - Type Unspecified