Provider Demographics
NPI:1811039308
Name:WESTLAKE PHARMACY, INC.
Entity Type:Organization
Organization Name:WESTLAKE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-426-9919
Mailing Address - Street 1:815 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-5303
Mailing Address - Country:US
Mailing Address - Phone:205-426-9919
Mailing Address - Fax:205-426-9980
Practice Address - Street 1:815 8TH ST N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-5303
Practice Address - Country:US
Practice Address - Phone:205-426-9919
Practice Address - Fax:205-426-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002196Medicaid
AL0008220070Medicare NSC