Provider Demographics
NPI:1063706182
Name:SWALE, BERNADINE ELIZABETH
Entity type:Individual
Prefix:
First Name:BERNADINE
Middle Name:ELIZABETH
Last Name:SWALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16910 E QUINCY AVE
Mailing Address - Street 2:T0256
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2745
Mailing Address - Country:US
Mailing Address - Phone:303-680-3284
Mailing Address - Fax:303-680-3284
Practice Address - Street 1:16910 E QUINCY AVE
Practice Address - Street 2:T0256
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2745
Practice Address - Country:US
Practice Address - Phone:303-680-3284
Practice Address - Fax:303-680-3284
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist