Provider Demographics
NPI:1770668907
Name:WESTWOOD PHARMACY
Entity type:Organization
Organization Name:WESTWOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:530-256-3784
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96137-0880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 BIRCH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:96137-0880
Practice Address - Country:US
Practice Address - Phone:530-256-3784
Practice Address - Fax:530-256-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY19462333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA194620Medicaid
0500985OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0500985OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1280030001Medicare ID - Type Unspecified