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General NPI Number Information
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NPI Number | 1801976675
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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 | 10/16/2006
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 3201 S 16TH ST STE 1030
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City | MILWAUKEE
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State | WI
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Zip | 53215-4532
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Country | US
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Telephone | 414-384-1660
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Fax | 414-384-1753
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Provider Business Mailing Address
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Address Line | 3201 S 16TH ST STE 1030
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City | MILWAUKEE
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State | WI
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Zip | 53215-4532
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Country | US
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Telephone | 414-384-1660
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Fax | 414-384-1753
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Authorized Official
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Title or Position | OWNER
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Name | JAMES HOFBAUER
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Credential |
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Telephone | 414-384-1660
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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 | 6817042
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License Number State | WI
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