Healthcare Provider Details

I. General information

NPI: 1508087008
Provider Name (Legal Business Name): KATHERINE N SWIFT RPH CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 SANDERS RD NBT 15-2N
NORTHBROOK IL
60062-6150
US

IV. Provider business mailing address

27718 N OAK ST
ISLAND LAKE IL
60042-8415
US

V. Phone/Fax

Practice location:
  • Phone: 847-559-5654
  • Fax: 847-559-4949
Mailing address:
  • Phone: 847-526-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051-030104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: