Provider Demographics
NPI:1922106962
Name:MIKE SWAIM & VAN SWAIM & BOB
Entity Type:Organization
Organization Name:MIKE SWAIM & VAN SWAIM & BOB
Other - Org Name:BOBS DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:731-364-2207
Mailing Address - Street 1:8720 HIGHWAY 22
Mailing Address - Street 2:STE A
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-4348
Mailing Address - Country:US
Mailing Address - Phone:731-364-2207
Mailing Address - Fax:731-364-2173
Practice Address - Street 1:8720 HIGHWAY 22
Practice Address - Street 2:STE A
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-4348
Practice Address - Country:US
Practice Address - Phone:731-364-2207
Practice Address - Fax:731-364-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN3313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4406030Medicaid
2095273OtherPK
1254820001Medicare NSC