Provider Demographics
NPI:1538442900
Name:SWANEPOEL, ELMA (DR)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:
Last Name:SWANEPOEL
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36114 BLUFF OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3054
Mailing Address - Country:US
Mailing Address - Phone:225-677-9376
Mailing Address - Fax:225-664-3721
Practice Address - Street 1:730 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4401
Practice Address - Country:US
Practice Address - Phone:225-664-9452
Practice Address - Fax:225-664-3721
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.017329183500000X
TX17329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist