Provider Demographics
NPI:1902993116
Name:SWANSON PHARMACY INC
Entity Type:Organization
Organization Name:SWANSON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-935-3443
Mailing Address - Street 1:316 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1300
Mailing Address - Country:US
Mailing Address - Phone:608-935-3443
Mailing Address - Fax:608-935-3443
Practice Address - Street 1:316 W SPRING ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1300
Practice Address - Country:US
Practice Address - Phone:608-935-3443
Practice Address - Fax:608-935-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6110042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5114436OtherNABP
WI33015000Medicaid
WI0770920001Medicare ID - Type Unspecified