Provider Demographics
NPI:1477567709
Name:SWENBERG, GWEN ELLINGSON (RPH CPP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:ELLINGSON
Last Name:SWENBERG
Suffix:
Gender:F
Credentials:RPH CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 STONERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-9775
Mailing Address - Country:US
Mailing Address - Phone:919-968-4283
Mailing Address - Fax:
Practice Address - Street 1:UNC CAMPUS HEALTH JAMES A TAYLOR BLDG
Practice Address - Street 2:CB 7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-6556
Practice Address - Fax:919-966-6431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist