WEST SIDE PHARMACY, INC. (NPI# 1366060576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366060576 |
| Entity Type | Organization |
| Organization Name | WEST SIDE PHARMACY, INC. |
| Other Organization Name | WEST SIDE CLINICAL SERVICES |
| Practice Address |
620 W South St Benton AR 72015-4258 |
| Practice Telephone | 5017783151 |
| Practice Fax Number | 5017787329 |
| Mailing Telephone | 5017783151 |
| Mailing Fax Number | 5017787329 |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-10-19 |
| Authorized Official Name | BLAKE TORRES (OWNER) |
| Authorized Official Telephone | 5017783151 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| West Side Clinical Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750399515 | West Side Pharmacy, Inc. | Pharmacy | 620 W South St Ste C, Benton, AR 72015-4235 | 2006-08-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | WEST SIDE PHARMACY, INC. | 5345 East River Road, Grand Island, Ny 14072 |
| Massachusetts Corporations | WEST SIDE PHARMACY, INC., OF LEOMINSTER | 192 Merriam Ave., Leominster, MA 01453 |
| Street Address |
620 W SOUTH ST |
| City | BENTON |
| State | AR |
| Zip Code | 72015-4258 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528464054 | Kacey Jo Kiker | Nurse Practitioner | 620 W South St, Benton, AR 72015 | 2014-11-11 |
| 1912506056 | James Zackary Haley | Pharmacist | 620 W South St, Benton, AR 72015-4258 | 2020-10-20 |
| 1417579970 | Tammi Sue Haley | Pharmacist | 620 W South St, Benton, AR 72015-4258 | 2020-05-07 |
| 1952949448 | Allie Danielle Staton | Pharmacist | 620 W South St, Benton, AR 72015-4258 | 2019-12-15 |
| 1144870957 | West Side Pharmacy Inc. | Pharmacy | 620 W South St, Benton, AR 72015-4258 | 2019-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790343135 | Justin King | Case Manager/Care Coordinator | 1502 Mary Kay Blv6, Benton, AR 72015 | 2019-05-31 |
| 1790253326 | Seth Alexander Weisheit | Nurse Practitioner | 824 Military Road, Benton, AR 72015 | 2018-11-13 |
| 1396269627 | Abby G Sims | Speech-Language Pathologist | 3391 Peachtree Lane, Benton, AR 72015 | 2017-07-28 |
| 1225551278 | Jessica R Poe | Case Manager/Care Coordinator | 1502 Marykay Blvd, Benton, AR 72015 | 2017-07-21 |
| 1003357997 | Jamaal Langston | Case Manager/Care Coordinator | 1502 Mark Kay Blvd, Benton, AR 72015 | 2017-03-13 |
| 1881138550 | Shannon Gachot-ridgley | Counselor | 205 South Street Suite 3, Benton, AR 72015 | 2016-12-14 |
| 1295104578 | Excel Health of Haskell, Pllc | Clinical Nurse Specialist | 6029 Us Hwy 67, Haskell, AR 72015 | 2015-09-17 |
| 1700218252 | Jamie Brunt | Licensed Practical Nurse | 1718 Old Hot Springs Rd, Benton, AR 72015 | 2013-08-07 |
| 1760738942 | Kari J Richards | Physical Therapist | 5701 Springhill Rd, Bryant, AR 72015 | 2012-07-25 |
| 1265708945 | Tracey Leigh Zeiner | Occupational Therapist | 5701 Springhill Road, Bryant, AR 72015 | 2012-03-28 |
| Find all providers in zip 72015 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588270581 | Wk Palmetto Family Practice | Family Medicine | 4200 Palmetto Rd, Benton, LA 71006-9420 | 2020-09-16 |
| 1245641273 | Austin Beck | Family Medicine | 83 Wellness Way Lane, 1st Floor, Benton, KY 42025-7156 | 2014-05-13 |
| 1245415389 | Comprehensive Family Health Care LLC | Family Medicine | 142 S Winchester St, Benton, MO 63736-0000 | 2008-01-08 |
| 1891816153 | Patricia G Mcgarry | Family Medicine | 6640 Congo Rd., Benton, AR 72019-6913 | 2007-04-03 |
| 1477605988 | Marshall County Medical Associates | Family Medicine | 145 Vine Street, Benton, KY 42025 | 2007-01-17 |
| 1235209198 | Lisa Rebecca Barker | Family Medicine | 1304 Military Rd, Benton, AR 72015-2911 | 2006-11-08 |
| 1194821884 | Troy Glen Moore | Family Medicine | 5539 Atlantic Cv, Benton, AR 72019-8563 | 2006-09-16 |
| 1619071024 | Marvin Norwood Kirk | Family Medicine | 1102 B W. South Street, Benton, AR 72015-4066 | 2006-09-08 |
| 1780797035 | Aleksander Ivanovich Malakhov | Family Medicine | Highway 411 South, Benton, TN 37307-0308 | 2006-08-17 |
| 1215956602 | Ralph I Latta | Family Medicine | 501 N Duquoin, Benton, IL 62812-5228 | 2006-07-18 |
| Find all providers in BENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.