Provider Demographics
NPI:1881000339
Name:WESTGATERX PHARMACY
Entity type:Organization
Organization Name:WESTGATERX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:602-703-7275
Mailing Address - Street 1:8914 N 91ST AVE
Mailing Address - Street 2:S 100C
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8396
Mailing Address - Country:US
Mailing Address - Phone:623-249-4900
Mailing Address - Fax:623-249-4409
Practice Address - Street 1:8914 N 91ST AVE
Practice Address - Street 2:S 100C
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8396
Practice Address - Country:US
Practice Address - Phone:623-249-4900
Practice Address - Fax:623-249-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0059053336C0003X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy