Provider Demographics
NPI:1558383067
Name:SOUTHWEST PHARMACY, INC.
Entity Type:Organization
Organization Name:SOUTHWEST PHARMACY, INC.
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, FACA, FIACP
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:601-684-2559
Practice Address - Street 1:312 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2708
Practice Address - Country:US
Practice Address - Phone:601-684-9602
Practice Address - Fax:601-684-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440090Medicaid
MS0407690005Medicare ID - Type Unspecified