Provider Demographics
NPI:1043215106
Name:SLAKOPER INC
Entity Type:Organization
Organization Name:SLAKOPER INC
Other - Org Name:MATS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAKOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-6413
Mailing Address - Street 1:701 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-5412
Mailing Address - Country:US
Mailing Address - Phone:215-785-3537
Mailing Address - Fax:215-781-9995
Practice Address - Street 1:701 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-5412
Practice Address - Country:US
Practice Address - Phone:215-785-3537
Practice Address - Fax:215-781-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410704L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081015OtherPK
PA1265109Medicaid
PA1265109Medicaid