Provider Demographics
NPI:1518501592
Name:SOUTHWEST PHARMACY INC
Entity Type:Organization
Organization Name:SOUTHWEST PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-684-9602
Mailing Address - Street 1:312 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2708
Mailing Address - Country:US
Mailing Address - Phone:601-684-9602
Mailing Address - Fax:
Practice Address - Street 1:3000 PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-9227
Practice Address - Country:US
Practice Address - Phone:601-377-1982
Practice Address - Fax:601-377-1980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-01
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy