Provider Demographics
NPI:1417243544
Name:SWEHLA, MICHELLE ELAINE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:SWEHLA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1445
Mailing Address - Country:US
Mailing Address - Phone:209-523-6210
Mailing Address - Fax:
Practice Address - Street 1:3405 MCHENRY AVE
Practice Address - Street 2:STORE 0273
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1445
Practice Address - Country:US
Practice Address - Phone:209-523-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist