Provider Demographics
NPI:1558086538
Name:SOUTHWEST PHARMACY, INC.
Entity Type:Organization
Organization Name:SOUTHWEST PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:601-684-4127
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:601-654-6505
Practice Address - Street 1:212 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2712
Practice Address - Country:US
Practice Address - Phone:601-524-4897
Practice Address - Fax:601-524-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy