Provider Demographics
NPI:1295118123
Name:SWINDLER, JASON DANIEL (BS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:SWINDLER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W HAVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4116
Mailing Address - Country:US
Mailing Address - Phone:605-292-4000
Mailing Address - Fax:605-292-4005
Practice Address - Street 1:1305 W HAVENS AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4116
Practice Address - Country:US
Practice Address - Phone:605-292-4000
Practice Address - Fax:605-292-4005
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist