Provider Demographics
NPI:1841599644
Name:WEST LAKE PHARMACY INC
Entity Type:Organization
Organization Name:WEST LAKE PHARMACY INC
Other - Org Name:WEST LAKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAPOLEON
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-344-4555
Mailing Address - Street 1:2544 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4637
Mailing Address - Country:US
Mailing Address - Phone:407-344-4555
Mailing Address - Fax:407-344-4566
Practice Address - Street 1:2544 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4637
Practice Address - Country:US
Practice Address - Phone:407-344-4555
Practice Address - Fax:407-344-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH252473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003526500Medicaid
2130063OtherPK