Provider Demographics
NPI:1356621650
Name:SWC PHARMACY LLC
Entity type:Organization
Organization Name:SWC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-213-0600
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-0710
Mailing Address - Country:US
Mailing Address - Phone:205-941-9945
Mailing Address - Fax:205-655-5102
Practice Address - Street 1:832 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1320
Practice Address - Country:US
Practice Address - Phone:205-397-4900
Practice Address - Fax:205-206-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1137943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137287OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL133298Medicaid