Provider Demographics
NPI:1629346895
Name:SWAMINATHAN, INDRADEVI (RPH)
Entity Type:Individual
Prefix:MS
First Name:INDRADEVI
Middle Name:
Last Name:SWAMINATHAN
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 1:514 NE 181ST AVE
Mailing Address - Street 2:RITE AID, STORE # 5357 ,
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6702
Mailing Address - Country:US
Mailing Address - Phone:503-661-6991
Mailing Address - Fax:
Practice Address - Street 1:514 NE 181ST AVE
Practice Address - Street 2:RITE AID, STORE # 5357 ,
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6702
Practice Address - Country:US
Practice Address - Phone:503-661-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist