# WEST SIDE PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West Side Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750399515
- **Authorized official:** MARK HAYNES (OFFICE MANAGER)
- **Authorized official phone:** (501) 778-8062

## Contact information

- **Practice address:** 620 W SOUTH ST STE C, BENTON, AR 72015-4235
- **Practice address phone:** (501) 778-3151
- **Practice address fax:** (501) 778-7329
- **Mailing address:** 620 W SOUTH ST STE C, BENTON, AR 72015-4235
- **Mailing address phone:** (501) 778-3151
- **Mailing address fax:** (501) 778-7329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | AR01745 | AR | Yes |

## Other

- **Enumeration date:** 08/04/2006
- **Last updated:** 08/22/2020