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General NPI Number Information
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NPI Number | 1689382673
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Entity Type | Individual
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Provider Name | ALEXA NICOLE SWAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 3036 NE MARTIN LUTHER KING JR BLVD STE 136
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City | PORTLAND
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State | OR
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Zip | 97212-3053
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Country | US
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Telephone | 35-056-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 4888 SW LAURELWOOD AVE
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City | PORTLAND
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State | OR
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Zip | 97225-1824
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Country | US
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Telephone | 360-936-8393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0019250
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License Number State | OR
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