Provider Demographics
NPI:1043407406
Name:SWIFT, MATTHEW E (RPH , PHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:SWIFT
Suffix:
Gender:M
Credentials:RPH , PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-913-5287
Mailing Address - Fax:505-913-4949
Practice Address - Street 1:465 SAINT MICHAELS DR STE 114
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7621
Practice Address - Country:US
Practice Address - Phone:505-913-5287
Practice Address - Fax:505-913-4949
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist