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General NPI Number Information
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NPI Number | 1164770822
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Entity Type | Organization
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Legal Business Name | S & W HEALTHCARE
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 603 N HWY 160
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City | ALTON
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State | MO
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Zip | 65606
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Country | US
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Telephone | 417-778-7727
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Fax | 417-778-6820
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | DONIPHAN
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State | MO
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Zip | 63935-0441
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Country | US
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Telephone | 573-996-3784
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Fax | 573-996-1872
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | PHILLIP WILKINS
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Credential |
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Telephone | 573-996-3784
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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 | 2012025843
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License Number State | MO
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