Provider Information for 1043497480
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WESTERN STATE HOSPITAL PHARMACY
Organization Subpart: NO
NPI: 1043497480
Last Updated: 2008-01-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1043497480 | ||||||||||||
| Enumeration Date | 2008-01-29 | ||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||
| Status | Active | ||||||||||||
| Authorized Official Information | Name: Mr. ROGER WESTFALL Title: Director of Administrative Services Phone: 2708896025 | ||||||||||||
| Mailing Address | 2400 RUSSELLVILLE RD HOPKINSVILLE, KY 42240-8095 United States Phone: 270-889-6025 | Fax:270-889-5062 | ||||||||||||
| Primary Practice Address | 2400 RUSSELLVILLE RD HOPKINSVILLE, KY 42240-8095 United States Phone: 270-889-6025 | Fax:270-889-5062 | ||||||||||||
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