Provider Demographics
NPI:1124364153
Name:SLAVEC, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SLAVEC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 ARAPAHOE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6714
Mailing Address - Country:US
Mailing Address - Phone:303-443-6142
Mailing Address - Fax:303-245-0435
Practice Address - Street 1:2798 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6714
Practice Address - Country:US
Practice Address - Phone:303-443-6142
Practice Address - Fax:303-245-0435
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist