Provider Demographics
NPI:1467409581
Name:SLAUGHTER, DIANE BURTON (DPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:BURTON
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 E LIONS GATE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7813
Mailing Address - Country:US
Mailing Address - Phone:901-332-3590
Mailing Address - Fax:901-545-8884
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:MEDPLEX PHARMACY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-6299
Practice Address - Fax:901-545-8884
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist