Provider Demographics
NPI:1841231271
Name:WEST SHORE PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:WEST SHORE PROFESSIONAL PHARMACY INC
Other - Org Name:WEST SHORE PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGENGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-1950
Mailing Address - Street 1:1150 E SHERMAN BOULAVARD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1870
Mailing Address - Country:US
Mailing Address - Phone:231-672-2204
Mailing Address - Fax:231-672-3799
Practice Address - Street 1:1150 E SHERMAN BOULAVARD
Practice Address - Street 2:SUITE 1400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1870
Practice Address - Country:US
Practice Address - Phone:231-672-2204
Practice Address - Fax:231-672-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010031353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2041196OtherPK