Provider Demographics
NPI:1689277493
Name:SWAIN, KRISTIN ALIDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ALIDA
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15101 BRABRAND LN
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2416
Mailing Address - Country:US
Mailing Address - Phone:804-883-3178
Mailing Address - Fax:
Practice Address - Street 1:18048 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2922
Practice Address - Country:US
Practice Address - Phone:804-448-3216
Practice Address - Fax:804-212-1268
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist