Healthcare Provider Details

I. General information

NPI: 1346699030
Provider Name (Legal Business Name): SUCCESSWARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 BONANZA DR SUITE 107
PARK CITY UT
84060
US

IV. Provider business mailing address

1710 HIGHWAY 34
WALL TOWNSHIP NJ
07727-3906
US

V. Phone/Fax

Practice location:
  • Phone: 435-776-7525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALEXANDE MCDANIEL
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 732-919-1234