Provider Demographics
NPI:1841440682
Name:WEST ATLANTIC PHARMACY INCORPORATED
Entity type:Organization
Organization Name:WEST ATLANTIC PHARMACY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA (AMY)
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKA-SHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-496-0338
Mailing Address - Street 1:7495 W ATLANTIC AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1393
Mailing Address - Country:US
Mailing Address - Phone:561-496-0338
Mailing Address - Fax:561-496-0832
Practice Address - Street 1:7495 W ATLANTIC AVE
Practice Address - Street 2:STE 206
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1393
Practice Address - Country:US
Practice Address - Phone:561-496-0338
Practice Address - Fax:561-496-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0214001608333600000X
FLPH235483336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000641500Medicaid
2117115OtherPK