Provider Demographics
NPI:1275124398
Name:SLAGLE, JOHN R (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SLAGLE
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 1:100 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1808
Mailing Address - Country:US
Mailing Address - Phone:814-226-9310
Mailing Address - Fax:814-226-9329
Practice Address - Street 1:100 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1808
Practice Address - Country:US
Practice Address - Phone:814-226-9310
Practice Address - Fax:814-226-9329
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP32530L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007724210005Medicaid