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General NPI Number Information
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NPI Number | 1407911613
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Entity Type | Organization
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Legal Business Name | SOUTHWELL PHARMACY
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1802 LEE AVENUE
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-353-6756
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Fax | 229-353-6531
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Provider Business Mailing Address
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Address Line | 1802 LEE AVENUE
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-353-6756
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Fax | 229-353-6531
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER KEITH DORMAN
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Credential |
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Telephone | 229-382-7120
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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 |
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License Number State |
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