Healthcare Provider Details

I. General information

NPI: 1003968488
Provider Name (Legal Business Name): SOUTHWOOD PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 RAFFIA RD
ENFIELD CT
06082-5157
US

IV. Provider business mailing address

89 RAFFIA RD
ENFIELD CT
06082-5157
US

V. Phone/Fax

Practice location:
  • Phone: 860-749-8334
  • Fax: 860-749-8156
Mailing address:
  • Phone: 860-749-8334
  • Fax: 860-749-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number528
License Number StateCT

VIII. Authorized Official

Name: EDWARD SZEWCZYK
Title or Position: PRES
Credential: BS
Phone: 860-749-8334