Provider Demographics
NPI:1124191366
Name:SOUTHWEST CORPORATION PHARMACY
Entity Type:Organization
Organization Name:SOUTHWEST CORPORATION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:203-899-0708
Mailing Address - Street 1:120 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1525
Mailing Address - Country:US
Mailing Address - Phone:203-899-0708
Mailing Address - Fax:
Practice Address - Street 1:120 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1525
Practice Address - Country:US
Practice Address - Phone:203-899-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT16813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004191954Medicaid
0718087OtherNABP