Provider Demographics
NPI:1366712630
Name:SWAGER, WILLIAM EUGENE IV
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:SWAGER
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14546 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3851
Mailing Address - Country:US
Mailing Address - Phone:727-743-2694
Mailing Address - Fax:727-596-7710
Practice Address - Street 1:14004 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3232
Practice Address - Country:US
Practice Address - Phone:727-596-5122
Practice Address - Fax:727-596-7710
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS21200OtherPHARMACIST LICENSE NUMBER