Provider Demographics
NPI:1750674917
Name:SWENDIG, JON CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:CHARLES
Last Name:SWENDIG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2640
Mailing Address - Country:US
Mailing Address - Phone:208-664-3185
Mailing Address - Fax:208-664-3481
Practice Address - Street 1:208 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2640
Practice Address - Country:US
Practice Address - Phone:208-664-3185
Practice Address - Fax:208-664-3481
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist