Provider Demographics
NPI:1265033872
Name:SWARY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SWARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11527 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:OH
Mailing Address - Zip Code:43527-9729
Mailing Address - Country:US
Mailing Address - Phone:419-439-1078
Mailing Address - Fax:
Practice Address - Street 1:1215 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-2442
Practice Address - Country:US
Practice Address - Phone:419-636-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist