Provider Demographics
NPI:1659464105
Name:SWANSON DRUG INC.
Entity Type:Organization
Organization Name:SWANSON DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-275-2362
Mailing Address - Street 1:305 W.WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-0444
Mailing Address - Country:US
Mailing Address - Phone:515-275-2362
Mailing Address - Fax:515-275-4591
Practice Address - Street 1:305 W.WALNUT ST.
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IA
Practice Address - Zip Code:50212-0444
Practice Address - Country:US
Practice Address - Phone:515-275-2362
Practice Address - Fax:515-275-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0233486Medicaid
IA0145610001Medicare ID - Type Unspecified