Provider Demographics
NPI:1295566214
Name:SWAN PHARMACY INC
Entity type:Organization
Organization Name:SWAN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-252-5252
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30477-0069
Mailing Address - Country:US
Mailing Address - Phone:478-494-7733
Mailing Address - Fax:
Practice Address - Street 1:6581 GA 102
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:GA
Practice Address - Zip Code:30820
Practice Address - Country:US
Practice Address - Phone:478-252-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWAN PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy