Provider Demographics
NPI:1962414615
Name:SWANN, DON
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:SWANN
Suffix:
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 1:13008 LORIEN WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-0402
Mailing Address - Country:US
Mailing Address - Phone:580-623-4505
Mailing Address - Fax:
Practice Address - Street 1:407 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-4233
Practice Address - Country:US
Practice Address - Phone:580-623-4505
Practice Address - Fax:580-623-4627
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist