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Organization
WESTERN PHARMACY GROUP LLC
Active
Organization
WESTERN PHARMACY GROUP LLC
Active
Other names
MEDICAL CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN FARIS (CEO)
(360) 220-4818
Entity
Organization
Contact information
Practice address
3904 PARK BLVD, SAN DIEGO, CA 92103-3502
(619) 295-3109
(619) 295-6478
Mailing address
851 COHO WAY STE 312, BELLINGHAM, WA 98225-2066
(360) 685-4263
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
55910
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175999
PK
—
Enumeration date
06/09/2008
Last updated
07/19/2018
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