MEDICARE: DR. STACEY M SWARTZ PHARM.D.

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	183500000X	Pharmacist	0202206558	VA

General Provider Information

NPI Number	:	1619973252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY M SWARTZ PHARM.D.

Provider Business Mailing Address
First Line	:	417 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-2233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2204 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1362
Country	:	US
Telephone Number	:	703-836-1700
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/04/2015

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