Provider Demographics
NPI:1477876332
Name:NASRADINAJ-SWIFT, JENNIFER (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NASRADINAJ-SWIFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 GENESEE VALLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9434
Mailing Address - Country:US
Mailing Address - Phone:585-243-9020
Mailing Address - Fax:585-243-9516
Practice Address - Street 1:4287 GENESEE VALLEY PLZ
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9434
Practice Address - Country:US
Practice Address - Phone:585-243-9020
Practice Address - Fax:585-243-9516
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050985OtherPHARMACIST LICENSE #