Provider Demographics
NPI:1841608700
Name:SWENCKI, LAURA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SWENCKI
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 1:192 OVERLAND RDG
Mailing Address - Street 2:APT. 162
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-7233
Mailing Address - Country:US
Mailing Address - Phone:270-318-9703
Mailing Address - Fax:
Practice Address - Street 1:629 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-6001
Practice Address - Country:US
Practice Address - Phone:859-234-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist