Provider Demographics
NPI:1780210179
Name:SEWALL'S POINT PHARMACY INC
Entity Type:Organization
Organization Name:SEWALL'S POINT PHARMACY INC
Other - Org Name:SEWALL'S POINT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:772-600-8077
Mailing Address - Street 1:3754 SE OCEAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-6700
Mailing Address - Country:US
Mailing Address - Phone:772-600-8077
Mailing Address - Fax:772-600-5576
Practice Address - Street 1:3754 SE OCEAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-6700
Practice Address - Country:US
Practice Address - Phone:726-008-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32759OtherSTATE BOARD OF PHARMACY
5744671OtherNCPDP