Basic Information
| Provider Information | |||||||||
| NPI: | 1831759307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWENDSEN | ||||||||
| FirstName: | KENADI | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | CPHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 HIRD AVE APT 5 | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836052059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085145982 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 700 12TH AVE S | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836514255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085145982 | ||||||||
| FaxNumber: | 2084671823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | CT51091 | ID | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.