MEDICARE: STEVEN ROBERT SWITALA R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835G0303X	Geriatric Pharmacist	28042	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28042	OTHER	TX	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1033257464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ROBERT SWITALA R.PH.

Provider Business Mailing Address
First Line	:	3408 ROLLING HILLS LN
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-6852
Country	:	US
Telephone Number	:	817-488-5731
Fax Number	:	817-633-6678

Provider Business Practice Location Address
First Line	:	610 MAGIC MILE ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5108
Country	:	US
Telephone Number	:	817-633-6688
Fax Number	:	817-633-6678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	04/21/2014

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