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Organization
WEST SIDE DRUG CO A CORP
Active
Organization
WEST SIDE DRUG CO A CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF LOUIE (TRES)
(559) 659-2159
Entity
Organization
Contact information
Practice address
1101 O ST, FIREBAUGH, CA 93622-2224
(559) 659-2159
(559) 659-2985
Mailing address
1101 O ST, FIREBAUGH, CA 93622-2224
(559) 659-2159
(559) 659-2985
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY10636
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780795377
—
CA
05
—
PHA106360
—
CA
Enumeration date
08/31/2006
Last updated
06/03/2015
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