Provider Demographics
NPI:1629676143
Name:SLOAN, ROBERTA G (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:G
Last Name:SLOAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HARTLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1558
Mailing Address - Country:US
Mailing Address - Phone:859-245-5855
Mailing Address - Fax:
Practice Address - Street 1:4750 HARTLAND PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1558
Practice Address - Country:US
Practice Address - Phone:859-245-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist