Provider Demographics
NPI:1205162187
Name:SWINEHART, HOLLY M (RPH)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:M
Last Name:SWINEHART
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27442 280 ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-8104
Mailing Address - Country:US
Mailing Address - Phone:660-686-2886
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1544
Practice Address - Country:US
Practice Address - Phone:660-736-5512
Practice Address - Fax:660-736-4361
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist