Provider Demographics
NPI:1578202586
Name:SWANSON, ERIK MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:MICHAEL
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1508
Mailing Address - Country:US
Mailing Address - Phone:218-390-1997
Mailing Address - Fax:
Practice Address - Street 1:3605 MAYFAIR AVE STE 2
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2936
Practice Address - Country:US
Practice Address - Phone:218-262-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1252571835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN125257OtherPHARMACIST LICENSE