Provider Demographics
NPI:1336531458
Name:SWAFFORD, CLARISSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:SWAFFORD
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 1:112 CRIMSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752
Mailing Address - Country:US
Mailing Address - Phone:706-657-3734
Mailing Address - Fax:706-657-3734
Practice Address - Street 1:112 CRIMSON DRIVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752
Practice Address - Country:US
Practice Address - Phone:706-657-3734
Practice Address - Fax:706-657-3734
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020360183500000X
TN010211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist