Provider Demographics
NPI:1083937106
Name:SWIERSZ, MIKE HENRY
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:HENRY
Last Name:SWIERSZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1259
Mailing Address - Country:US
Mailing Address - Phone:217-431-6006
Mailing Address - Fax:
Practice Address - Street 1:2721 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1493
Practice Address - Country:US
Practice Address - Phone:217-443-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist