Provider Demographics
NPI:1194010264
Name:SWAN, PAUL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:SWAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 18TH AVE NW
Mailing Address - Street 2:T-1173
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-9337
Mailing Address - Country:US
Mailing Address - Phone:507-437-7053
Mailing Address - Fax:507-437-7053
Practice Address - Street 1:1701 18TH AVE NW
Practice Address - Street 2:T-1173
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-9337
Practice Address - Country:US
Practice Address - Phone:507-437-7053
Practice Address - Fax:507-437-7053
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist