Healthcare Provider Details

I. General information

NPI: 1619015674
Provider Name (Legal Business Name): SBW PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 N HERMITAGE RD STE 6
TRANSFER PA
16154-1852
US

IV. Provider business mailing address

PO BOX 103
TRANSFER PA
16154-0103
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-1131
  • Fax: 724-646-1177
Mailing address:
  • Phone: 724-646-1131
  • Fax: 724-646-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP412067L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412067L
License Number StatePA

VIII. Authorized Official

Name: MR. BRETTON CLARK WALBERG
Title or Position: PRESIDENT
Credential: RPH
Phone: 724-612-2131