Provider Demographics
NPI:1093841272
Name:SWENSON, ELISE (RPH, CDE, MS, MAOM)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:RPH, CDE, MS, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 STERN DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5386
Mailing Address - Country:US
Mailing Address - Phone:801-265-1092
Mailing Address - Fax:
Practice Address - Street 1:220 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2106
Practice Address - Country:US
Practice Address - Phone:801-521-4118
Practice Address - Fax:801-521-8936
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy