Healthcare Provider Details

I. General information

NPI: 1316982010
Provider Name (Legal Business Name): S.E.W. ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CUBA RD
MAYFIELD KY
42066-6809
US

IV. Provider business mailing address

1520 CUBA RD
MAYFIELD KY
42066-6809
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-3345
  • Fax: 270-247-1344
Mailing address:
  • Phone: 270-247-3345
  • Fax: 270-247-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07701
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberP07700
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MYKEL TIDWELL
Title or Position: PRESIDENT
Credential:
Phone: 270-247-3345