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General NPI Number Information
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NPI Number | 1285987461
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PHARMACY INC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 1005 W CONGRESS ST
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2603
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Country | US
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Telephone | 601-684-4127
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Fax | 601-684-8479
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Provider Business Mailing Address
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Address Line | 312 MARION AVE
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City | MCCOMB
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State | MS
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Zip | 39648-2708
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Country | US
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Telephone | 601-684-4127
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Fax | 601-684-8479
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOE KEITH GUY
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Credential | RPH
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Telephone | 601-684-4127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 11696/1.1
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11696/1.1
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License Number State | MS
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