Provider Demographics
NPI:1124301163
Name:SWAGER, TIMOTHY B (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:SWAGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15184 LAWRENCE 1225
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-7156
Mailing Address - Country:US
Mailing Address - Phone:417-463-7381
Mailing Address - Fax:
Practice Address - Street 1:1955 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2214
Practice Address - Country:US
Practice Address - Phone:417-881-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005007839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist