Provider Demographics
NPI:1922832328
Name:SWANSBURG, RYAN DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:SWANSBURG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SHERMAN ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2150
Mailing Address - Country:US
Mailing Address - Phone:978-701-4418
Mailing Address - Fax:
Practice Address - Street 1:446 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4111
Practice Address - Country:US
Practice Address - Phone:207-783-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR72168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist