Provider Demographics
NPI:1083045280
Name:SWANSON, CARL II (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:SWANSON
Suffix:II
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:CARL
Other - Middle Name:N A
Other - Last Name:SWANSON
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:10 CLARA DR
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1957
Mailing Address - Country:US
Mailing Address - Phone:860-536-4606
Mailing Address - Fax:860-536-9629
Practice Address - Street 1:10 CLARA DR
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1957
Practice Address - Country:US
Practice Address - Phone:860-536-4606
Practice Address - Fax:860-536-9629
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012165183500000X
MAPH 233749183500000X
MI5302035416183500000X
MN114018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist