Healthcare Provider Details

I. General information

NPI: 1437269727
Provider Name (Legal Business Name): MR. ERIC ALAN SWOPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24187 FRONT ST
GRAND RAPIDS OH
43522-9410
US

IV. Provider business mailing address

17575 SYCAMORE RD
GRAND RAPIDS OH
43522-9490
US

V. Phone/Fax

Practice location:
  • Phone: 419-832-4615
  • Fax: 419-832-0601
Mailing address:
  • Phone: 419-832-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-22520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: