Provider Demographics
NPI:1649662461
Name:SWARTWOUT, BIRGIT
Entity type:Individual
Prefix:
First Name:BIRGIT
Middle Name:
Last Name:SWARTWOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-2152
Mailing Address - Country:US
Mailing Address - Phone:715-384-9703
Mailing Address - Fax:715-384-4199
Practice Address - Street 1:1012 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2152
Practice Address - Country:US
Practice Address - Phone:715-384-9703
Practice Address - Fax:715-384-4199
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17352-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist