MEDICARE: KEVIN C SWANSON PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.291375	IL

General Provider Information

NPI Number	:	1952688053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN C SWANSON PHARM D.

Provider Business Mailing Address
First Line	:	700 N STONE AVE
Second Line	:
City	:	LA GRANGE PARK
State	:	IL
Zip	:	60526-1440
Country	:	US
Telephone Number	:	708-469-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S M L KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	312-326-4058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/03/2011

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