Provider Demographics
NPI:1063608099
Name:SWANSON, PATRICIA L (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-1033
Mailing Address - Country:US
Mailing Address - Phone:515-275-4595
Mailing Address - Fax:515-275-4591
Practice Address - Street 1:305 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IA
Practice Address - Zip Code:50212-3048
Practice Address - Country:US
Practice Address - Phone:515-275-2362
Practice Address - Fax:515-275-4591
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist