Healthcare Provider Details

I. General information

NPI: 1306396205
Provider Name (Legal Business Name): SWIPHT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S MISSION ST
SAPULPA OK
74066-4634
US

IV. Provider business mailing address

14 S MISSION ST
SAPULPA OK
74066-4634
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-2010
  • Fax: 917-227-2843
Mailing address:
  • Phone: 918-227-2010
  • Fax: 917-227-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11-5825
License Number StateOK

VIII. Authorized Official

Name: TRAVIS WOLFF
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 917-227-2010