Provider Demographics
NPI:1114527488
Name:SWENSEN, ERIC DALE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DALE
Last Name:SWENSEN
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 1:1055 W HILL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4614
Mailing Address - Country:US
Mailing Address - Phone:801-444-6657
Mailing Address - Fax:801-444-6659
Practice Address - Street 1:1055 W HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4614
Practice Address - Country:US
Practice Address - Phone:801-444-6657
Practice Address - Fax:801-444-6659
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6157937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist