Provider Demographics
NPI:1083986814
Name:SLOVACEK, DENNIS MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MARTIN
Last Name:SLOVACEK
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 1:2270 W 400 N
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-6103
Mailing Address - Country:US
Mailing Address - Phone:762-362-6482
Mailing Address - Fax:
Practice Address - Street 1:1400 E IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3452
Practice Address - Country:US
Practice Address - Phone:574-231-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26091690A183500000X
IL051026948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist