Provider Demographics
NPI:1972055846
Name:SWANBERRY, JEFFREY T (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:T
Last Name:SWANBERRY
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 1:69 NORTH MARKET ST.
Mailing Address - Street 2:MEDICINE SHOPPE
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634
Mailing Address - Country:US
Mailing Address - Phone:570-735-2300
Mailing Address - Fax:570-258-2036
Practice Address - Street 1:69 NORTH MARKET ST.
Practice Address - Street 2:MEDICINE SHOPPE
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-735-2300
Practice Address - Fax:570-258-2036
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043378L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist