Provider Demographics
NPI:1619015674
Name:SBW PHARMACY, INC.
Entity Type:Organization
Organization Name:SBW PHARMACY, INC.
Other - Org Name:REYNOLDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETTON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-612-2131
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:TRANSFER
Mailing Address - State:PA
Mailing Address - Zip Code:16154-0103
Mailing Address - Country:US
Mailing Address - Phone:724-646-1131
Mailing Address - Fax:724-646-1177
Practice Address - Street 1:3676 N HERMITAGE RD STE 6
Practice Address - Street 2:
Practice Address - City:TRANSFER
Practice Address - State:PA
Practice Address - Zip Code:16154-1852
Practice Address - Country:US
Practice Address - Phone:724-646-1131
Practice Address - Fax:724-646-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412067L332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018507560001Medicaid
PA1018507560001Medicaid