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General NPI Number Information
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NPI Number | 1578751822
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PHARMACY
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 17115 RED OAK DR STE 105
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City | HOUSTON
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State | TX
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Zip | 77090-2607
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Country | US
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Telephone | 281-893-8665
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Fax | 281-893-8779
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Provider Business Mailing Address
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Address Line | 17115 RED OAK DR SUITE 105
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City | HOUSTON
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State | TX
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Zip | 77090-2641
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Country | US
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Telephone | 281-893-8665
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Fax | 281-893-8779
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Authorized Official
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Title or Position | PHARMACIST
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Name | NICHELLE STEWART
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Credential |
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Telephone | 713-453-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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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 | 23739
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License Number State | TX
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