Provider Demographics
NPI:1003920091
Name:SWEETWATER WORX LLC
Entity Type:Organization
Organization Name:SWEETWATER WORX LLC
Other - Org Name:WIL SAV DRUGS OF SWEETWATER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:SWAINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-472-0656
Mailing Address - Street 1:5032 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7091
Mailing Address - Country:US
Mailing Address - Phone:423-396-6963
Mailing Address - Fax:423-396-6947
Practice Address - Street 1:800 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1905
Practice Address - Country:US
Practice Address - Phone:423-337-9381
Practice Address - Fax:423-337-9382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN673336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149002OtherPK
TNQ032421Medicaid
4415192OtherOTHER ID NUMBER-COMMERCIAL NUMBER