Healthcare Provider Details

I. General information

NPI: 1164770822
Provider Name (Legal Business Name): S & W HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N HWY 160
ALTON MO
65606
US

IV. Provider business mailing address

PO BOX 441
DONIPHAN MO
63935-0441
US

V. Phone/Fax

Practice location:
  • Phone: 417-778-7727
  • Fax: 417-778-6820
Mailing address:
  • Phone: 573-996-3784
  • Fax: 573-996-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2012025843
License Number StateMO

VIII. Authorized Official

Name: PHILLIP WILKINS
Title or Position: MANAGER/MEMBER
Credential:
Phone: 573-996-3784