Provider Demographics
NPI:1962510339
Name:SWANTON DRUG, INC
Entity Type:Organization
Organization Name:SWANTON DRUG, INC
Other - Org Name:SWANTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH/OWNER
Authorized Official - Phone:419-825-5050
Mailing Address - Street 1:151 E. AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558
Mailing Address - Country:US
Mailing Address - Phone:419-825-5050
Mailing Address - Fax:419-825-2190
Practice Address - Street 1:151 E. AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558
Practice Address - Country:US
Practice Address - Phone:419-825-5050
Practice Address - Fax:419-825-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
OH0214592003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8605503Medicaid
3607376OtherOTHER ID NUMBER
3607376OtherOTHER ID NUMBER
OH5775560001Medicare NSC