Provider Demographics
NPI:1598859191
Name:MCSWAIN, MITCH D (RPH)
Entity Type:Individual
Prefix:
First Name:MITCH
Middle Name:D
Last Name:MCSWAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MAIN AVE SW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5219
Mailing Address - Country:US
Mailing Address - Phone:256-734-1662
Mailing Address - Fax:256-737-0682
Practice Address - Street 1:1910 MAIN AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5219
Practice Address - Country:US
Practice Address - Phone:256-734-1662
Practice Address - Fax:256-737-0682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0751980001Medicare ID - Type UnspecifiedPALMETTO GBA