Provider Demographics
NPI:1184781569
Name:WESTBANK PHARMACY
Entity type:Organization
Organization Name:WESTBANK PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHCST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DZUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-340-0777
Mailing Address - Street 1:3709 WESTBANK EXPR.
Mailing Address - Street 2:STE. 1C
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-340-0777
Mailing Address - Fax:504-340-0777
Practice Address - Street 1:3709 WESTBANK EXPR.
Practice Address - Street 2:STE. 1C
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-340-0777
Practice Address - Fax:504-340-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1771IR3336C0003X
333600000X
LA13383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA25429Medicaid
1919919OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1919919OtherOTHER ID NUMBER
1919919OtherOTHER ID NUMBER
1096570001Medicare NSC