Provider Demographics
NPI:1104102177
Name:WEST, TROY DOUGLAS
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:DOUGLAS
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E SHERIDAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1855
Mailing Address - Country:US
Mailing Address - Phone:218-365-7957
Mailing Address - Fax:218-365-2232
Practice Address - Street 1:1500 E SHERIDAN ST STE 100
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1855
Practice Address - Country:US
Practice Address - Phone:218-365-1855
Practice Address - Fax:218-365-2232
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist