Provider Demographics
NPI:1619263878
Name:SLATER, NATHAN SCOTT (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:SCOTT
Last Name:SLATER
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 1:9882 ADAMS AVE
Mailing Address - Street 2:T-2051
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4808
Mailing Address - Country:US
Mailing Address - Phone:714-849-1815
Mailing Address - Fax:
Practice Address - Street 1:9882 ADAMS AVE
Practice Address - Street 2:T-2051
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4808
Practice Address - Country:US
Practice Address - Phone:714-849-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist