Healthcare Provider Details

I. General information

NPI: 1548199490
Provider Name (Legal Business Name): ALEXANDREA BREE AN SWINNEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 42ND ST
MOUNT VERNON IL
62864-6266
US

IV. Provider business mailing address

415 S 42ND ST
MOUNT VERNON IL
62864-6266
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-9660
  • Fax: 618-244-9551
Mailing address:
  • Phone: 618-244-9660
  • Fax: 618-244-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number022407
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051307612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: