1326255522 NPI number — S & W PHARMACY, INC

Table of content: (NPI 1326255522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326255522 NPI number — S & W PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & W PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326255522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 CLEVELAND HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30721-8313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-259-9787
Provider Business Mailing Address Fax Number:
706-259-9174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 CLEVELAND HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30721-8313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-259-9787
Provider Business Practice Location Address Fax Number:
706-259-9174
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARTHUR
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PIC/OWNER
Authorized Official Telephone Number:
706-259-9787

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300028100B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000035406B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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