Provider Demographics
NPI:1033257464
Name:SWITALA, STEVEN ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:SWITALA
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 1:3408 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6852
Mailing Address - Country:US
Mailing Address - Phone:817-488-5731
Mailing Address - Fax:817-633-6678
Practice Address - Street 1:610 MAGIC MILE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5108
Practice Address - Country:US
Practice Address - Phone:817-633-6688
Practice Address - Fax:817-633-6678
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280421835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28042OtherPHARMACIST LICENSE NUMBER
TX28042OtherPHARMACIST LICENSE NUMBER