Provider Demographics
NPI:1275544835
Name:WAGENKNECHT & SWORDS INC.
Entity Type:Organization
Organization Name:WAGENKNECHT & SWORDS INC.
Other - Org Name:SWORDS' FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-0462
Mailing Address - Street 1:300 S OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4432
Mailing Address - Country:US
Mailing Address - Phone:660-826-0462
Mailing Address - Fax:660-826-5697
Practice Address - Street 1:300 S OHIO AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-4432
Practice Address - Country:US
Practice Address - Phone:660-826-0462
Practice Address - Fax:660-826-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MO0052803336L0003X
MOPS005280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601191307Medicaid
MO601191307Medicaid