Provider Demographics
NPI:1053523415
Name:SWAYZE, ROBERT ALAN (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:SWAYZE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7843
Mailing Address - Country:US
Mailing Address - Phone:503-810-1104
Mailing Address - Fax:
Practice Address - Street 1:3248 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-1655
Practice Address - Country:US
Practice Address - Phone:503-474-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5668183500000X
MI5302038558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist