Provider Demographics
NPI:1558608620
Name:SLADE, ROBERT DANIEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:SLADE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 N DESHON RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4797
Mailing Address - Country:US
Mailing Address - Phone:770-879-2706
Mailing Address - Fax:770-879-6513
Practice Address - Street 1:380 N DESHON RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4797
Practice Address - Country:US
Practice Address - Phone:770-879-2706
Practice Address - Fax:770-879-6513
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist