Provider Demographics
NPI:1598118200
Name:SOUTHWICK PHARMA, LLC
Entity Type:Organization
Organization Name:SOUTHWICK PHARMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIVAGAMA
Authorized Official - Middle Name:SUNDARI
Authorized Official - Last Name:DORAIRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-998-3446
Mailing Address - Street 1:549 COLLEGE HWY
Mailing Address - Street 2:UNIT B
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9821
Mailing Address - Country:US
Mailing Address - Phone:413-998-3446
Mailing Address - Fax:413-998-3157
Practice Address - Street 1:549 COLLEGE HWY
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9821
Practice Address - Country:US
Practice Address - Phone:413-998-3446
Practice Address - Fax:413-998-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADS900503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy