Healthcare Provider Details

I. General information

NPI: 1336069111
Provider Name (Legal Business Name): KERI SWAGER-SHUMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 RAWHIDE RD
BOULDER CITY NV
89005-3113
US

IV. Provider business mailing address

1453 RAWHIDE RD
BOULDER CITY NV
89005-3113
US

V. Phone/Fax

Practice location:
  • Phone: 702-743-9945
  • Fax:
Mailing address:
  • Phone: 702-743-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25129
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: