Provider Demographics
NPI:1912057605
Name:WEST, RALPH WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:WAYNE
Last Name:WEST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2256
Mailing Address - Country:US
Mailing Address - Phone:817-447-9723
Mailing Address - Fax:817-295-6128
Practice Address - Street 1:124 W RENFRO ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4260
Practice Address - Country:US
Practice Address - Phone:817-295-6128
Practice Address - Fax:817-295-5248
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist