Organization
POLARIS JACK, INC.
Active
Other names
Pure Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FORREST WESTLEY PHARMD (PRESIDENT)
(843) 293-7979
Entity
Organization
Contact information
Practice address
3072 DICK POND RD UNIT 2, MYRTLE BEACH, SC 29588-6954
(843) 293-7979
(843) 293-6499
Mailing address
3072 DICK POND RD UNIT 2, MYRTLE BEACH, SC 29588-6954
(843) 293-7979
(843) 293-6499
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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