Provider Demographics
NPI:1629138565
Name:SLATTUM, PATRICIA WAGNER (PHARMD, PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WAGNER
Last Name:SLATTUM
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20870 OLD NECK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-4132
Mailing Address - Country:US
Mailing Address - Phone:804-829-6650
Mailing Address - Fax:
Practice Address - Street 1:410 N 12TH ST
Practice Address - Street 2:SMITH RM 454, BOX 980533
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5062
Practice Address - Country:US
Practice Address - Phone:804-828-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020075371835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric