Provider Demographics
NPI:1902197338
Name:SWANEPOEL, HELOISE
Entity Type:Individual
Prefix:
First Name:HELOISE
Middle Name:
Last Name:SWANEPOEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 RIDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1135
Mailing Address - Country:US
Mailing Address - Phone:304-541-9015
Mailing Address - Fax:304-949-6097
Practice Address - Street 1:2700 E DUPONT AVE
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:WV
Practice Address - Zip Code:25015-1842
Practice Address - Country:US
Practice Address - Phone:304-949-6237
Practice Address - Fax:304-949-6097
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0006819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist