Healthcare Provider Details

I. General information

NPI: 1356621650
Provider Name (Legal Business Name): SWC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

PO BOX 710
TRUSSVILLE AL
35173-0710
US

V. Phone/Fax

Practice location:
  • Phone: 205-397-4900
  • Fax: 205-206-8464
Mailing address:
  • Phone: 205-941-9945
  • Fax: 205-655-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113794
License Number StateAL

VIII. Authorized Official

Name: KENNETH MINOR
Title or Position: VP OF PHARMACY OPERATIONS
Credential:
Phone: 205-213-0600