Provider Demographics
NPI:1194914119
Name:WESTBURY PHARMACY INC
Entity type:Organization
Organization Name:WESTBURY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:843-563-6635
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-0325
Mailing Address - Country:US
Mailing Address - Phone:843-563-9384
Mailing Address - Fax:843-563-9386
Practice Address - Street 1:701 N PARLER AVE
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2233
Practice Address - Country:US
Practice Address - Phone:843-563-9384
Practice Address - Fax:843-563-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96803336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC796808Medicaid
2093413OtherPK