Provider Demographics
NPI:1639479678
Name:SWENSEN, RYAN DEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
Last Name:SWENSEN
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 1:1553 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9219
Mailing Address - Country:US
Mailing Address - Phone:801-562-5400
Mailing Address - Fax:801-255-5669
Practice Address - Street 1:1553 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9219
Practice Address - Country:US
Practice Address - Phone:801-562-5400
Practice Address - Fax:801-255-5669
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353883-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist