Provider Demographics
NPI:1245315548
Name:SWAIM, RONNELL VAN (DPH)
Entity type:Individual
Prefix:MR
First Name:RONNELL
Middle Name:VAN
Last Name:SWAIM
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 S MCCOMBS ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3523
Mailing Address - Country:US
Mailing Address - Phone:731-587-9509
Mailing Address - Fax:731-588-5137
Practice Address - Street 1:319 S LINDELL ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2440
Practice Address - Country:US
Practice Address - Phone:731-587-9509
Practice Address - Fax:731-588-5137
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist