Provider Demographics
NPI:1790097814
Name:SWANSON, RYAN SAMUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SAMUEL
Last Name:SWANSON
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 1:1050 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5323
Mailing Address - Country:US
Mailing Address - Phone:919-776-4107
Mailing Address - Fax:919-775-1875
Practice Address - Street 1:1050 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5323
Practice Address - Country:US
Practice Address - Phone:919-776-4107
Practice Address - Fax:919-775-1875
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist