Provider Demographics
NPI:1194328401
Name:SWIPAS, BRENT J (RPH)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:SWIPAS
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 1:5177 OLD COLONY RD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9154
Mailing Address - Country:US
Mailing Address - Phone:330-219-4328
Mailing Address - Fax:
Practice Address - Street 1:9650 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-1050
Practice Address - Country:US
Practice Address - Phone:330-326-3851
Practice Address - Fax:330-326-2995
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist