Provider Demographics
NPI:1770868671
Name:SWINK, SUSAN ELIZABETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:SWINK
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 1:5141 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2620
Mailing Address - Country:US
Mailing Address - Phone:334-361-2261
Mailing Address - Fax:334-361-8524
Practice Address - Street 1:703 SOUTH MEMORIAL DR
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067
Practice Address - Country:US
Practice Address - Phone:334-361-2261
Practice Address - Fax:334-361-8524
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist