Provider Demographics
NPI:1902827975
Name:WEST KNOLL PHARMACY INC
Entity Type:Organization
Organization Name:WEST KNOLL PHARMACY INC
Other - Org Name:WEST KNOLL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-657-2027
Mailing Address - Street 1:PO BOX 69559
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-0559
Mailing Address - Country:US
Mailing Address - Phone:310-657-2027
Mailing Address - Fax:310-657-4035
Practice Address - Street 1:8547 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4120
Practice Address - Country:US
Practice Address - Phone:310-657-2027
Practice Address - Fax:310-657-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY442913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1995671OtherPK
CAPHA442910Medicaid
5382970001Medicare NSC