Provider Demographics
NPI:1699758425
Name:SWARTZ, BRIAN TODD (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TODD
Last Name:SWARTZ
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 1:8361 THORNAPPLE RIVER DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9568
Mailing Address - Country:US
Mailing Address - Phone:616-891-1674
Mailing Address - Fax:269-795-4928
Practice Address - Street 1:4652 N M 37 HWY
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8806
Practice Address - Country:US
Practice Address - Phone:269-795-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2540648Medicaid
MI2332346OtherNCPDP NUMBER
MI1964469Medicaid