Provider Demographics
NPI:1124112412
Name:SWOFFORD INC
Entity type:Organization
Organization Name:SWOFFORD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-478-5969
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-0189
Mailing Address - Country:US
Mailing Address - Phone:252-478-5969
Mailing Address - Fax:252-478-2978
Practice Address - Street 1:98 DODD ST
Practice Address - Street 2:
Practice Address - City:SPRING HOPE
Practice Address - State:NC
Practice Address - Zip Code:27882-9581
Practice Address - Country:US
Practice Address - Phone:252-478-5969
Practice Address - Fax:252-478-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC078913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0645440Medicaid
NC7703795Medicaid
2067390OtherPK
4700330001Medicare NSC
3411218OtherOTHER ID NUMBER-COMMERCIAL NUMBER