Provider Demographics
NPI:1689382673
Name:SWAN, ALEXA NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:NICOLE
Last Name:SWAN
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 1:4888 SW LAURELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1824
Mailing Address - Country:US
Mailing Address - Phone:360-936-8393
Mailing Address - Fax:
Practice Address - Street 1:3036 NE MARTIN LUTHER KING JR BLVD STE 136
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3053
Practice Address - Country:US
Practice Address - Phone:035-056-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist