Provider Demographics
NPI:1023454048
Name:SWANSON, FAYE TAYLOR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FAYE
Middle Name:TAYLOR
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 130TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1759
Mailing Address - Country:US
Mailing Address - Phone:425-885-6685
Mailing Address - Fax:
Practice Address - Street 1:702 TROSPER RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6934
Practice Address - Country:US
Practice Address - Phone:360-943-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60312180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60312180OtherWASHINGTON STATE PHARMACIST'S LICENSE