=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659464105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWANSON DRUG INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 W.WALNUT ST.
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50212-0444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-275-2362
-----------------------------------------------------
Fax | 515-275-4591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 W.WALNUT ST.
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50212-0444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-275-2362
-----------------------------------------------------
Fax | 515-275-4591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. PATRICIA L. SWANSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-275-2362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 23
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------