Provider Demographics
NPI:1124273537
Name:S & W PHARMACIES, INC
Entity type:Organization
Organization Name:S & W PHARMACIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:309-925-2400
Mailing Address - Street 1:220 W PEARL ST APT A
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-7905
Mailing Address - Country:US
Mailing Address - Phone:309-925-2400
Mailing Address - Fax:309-925-5301
Practice Address - Street 1:220 W PEARL ST APT A
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-7905
Practice Address - Country:US
Practice Address - Phone:309-925-2400
Practice Address - Fax:309-925-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5625780002Medicare NSC