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General NPI Number Information
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NPI Number | 1003968488
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Entity Type | Organization
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Legal Business Name | SOUTHWOOD PHARMACY, INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 89 RAFFIA RD
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City | ENFIELD
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State | CT
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Zip | 06082-5157
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Country | US
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Telephone | 860-749-8334
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Fax | 860-749-8156
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Provider Business Mailing Address
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Address Line | 89 RAFFIA RD
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City | ENFIELD
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State | CT
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Zip | 06082-5157
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Country | US
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Telephone | 860-749-8334
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Fax | 860-749-8156
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Authorized Official
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Title or Position | PRES
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Name | EDWARD SZEWCZYK
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Credential | BS
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Telephone | 860-749-8334
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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 | 528
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License Number State | CT
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