1356460943 NPI number — SWC CORPORATION

Table of content: (NPI 1356460943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356460943 NPI number — SWC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWC CORPORATION
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:
SWC PHARMACY INC
Provider Other Organization Name Type Code:
3
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:
1356460943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 STEVENS ST
Provider Second Line Business Mailing Address:
MAIN LOBBY
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06850-3852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-852-2690
Provider Business Mailing Address Fax Number:
203-852-2691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 STEVENS ST
Provider Second Line Business Practice Location Address:
MAIN LOBBY
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06850-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-852-2690
Provider Business Practice Location Address Fax Number:
203-852-2691
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEPKO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
203-852-2687

Provider Taxonomy Codes

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

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

  • Identifier: 004182581 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004173217 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com