Provider Demographics
NPI:1265643688
Name:SLATER, ERIC L (RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:SLATER
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 1:5959 W UTOPIA RD
Mailing Address - Street 2:APT. 2009
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7159
Mailing Address - Country:US
Mailing Address - Phone:623-792-8765
Mailing Address - Fax:
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7109
Practice Address - Country:US
Practice Address - Phone:623-362-3999
Practice Address - Fax:623-362-3919
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist