Provider Demographics
NPI:1851440879
Name:SWENSON, CRAIG S (RPH)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:S
Last Name:SWENSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-2016
Mailing Address - Country:US
Mailing Address - Phone:801-422-5171
Mailing Address - Fax:801-422-0812
Practice Address - Street 1:1750 NORTH WYMOUNT TERRACE DRIVE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602
Practice Address - Country:US
Practice Address - Phone:801-422-5171
Practice Address - Fax:801-422-0812
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144338-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist