Healthcare Provider Details

I. General information

NPI: 1073524666
Provider Name (Legal Business Name): SOUTHWEST HEMATOLOGY-ONCOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 21ST ST STE B
LUBBOCK TX
79410-1135
US

IV. Provider business mailing address

4002 21ST ST STE B
LUBBOCK TX
79410-1135
US

V. Phone/Fax

Practice location:
  • Phone: 806-793-8310
  • Fax: 806-793-7871
Mailing address:
  • Phone: 806-793-8310
  • Fax: 806-793-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15666
License Number StateTX

VIII. Authorized Official

Name: BRANCE WILSON
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 806-793-6654