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General NPI Number Information
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NPI Number | 1003920091
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Entity Type | Organization
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Legal Business Name | SWEETWATER WORX LLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 800 NEW HIGHWAY 68
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City | SWEETWATER
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State | TN
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Zip | 37874-1905
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Country | US
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Telephone | 423-337-9381
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Fax | 423-337-9382
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Provider Business Mailing Address
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Address Line | 5032 OOLTEWAH RINGGOLD RD SUITE 100
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City | OOLTEWAH
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State | TN
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Zip | 37363-7091
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Country | US
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Telephone | 423-396-6963
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Fax | 423-396-6947
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. JONATHAN SETH SWAINSON
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Credential | PHARMD
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Telephone | 423-472-0656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 67
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License Number State | TN
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