Provider Demographics
NPI:1295003176
Name:SLAUGHTER, KIM M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ARCANGEL CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1102
Mailing Address - Country:US
Mailing Address - Phone:415-256-9455
Mailing Address - Fax:
Practice Address - Street 1:790 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3218
Practice Address - Country:US
Practice Address - Phone:415-292-6155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist