Healthcare Provider Details

I. General information

NPI: 1780210179
Provider Name (Legal Business Name): SEWALL'S POINT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 02/06/2021
Certification Date: 02/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 SE OCEAN BLVD STE B
STUART FL
34996-6700
US

IV. Provider business mailing address

3754 SE OCEAN BLVD STE B
STUART FL
34996-6700
US

V. Phone/Fax

Practice location:
  • Phone: 726-008-0777
  • Fax:
Mailing address:
  • Phone: 772-600-8077
  • Fax: 772-600-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CRISTAL TOTTERMAN
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 772-600-8077