Provider Demographics
NPI:1639842560
Name:LOMAX, SLATER KEITH (PHARMD)
Entity Type:Individual
Prefix:
First Name:SLATER
Middle Name:KEITH
Last Name:LOMAX
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 1:1829 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-4654
Mailing Address - Country:US
Mailing Address - Phone:731-549-7872
Mailing Address - Fax:
Practice Address - Street 1:1971 TENNESSEE AVE N
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-5049
Practice Address - Country:US
Practice Address - Phone:731-847-4013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032645183500000X
AL21728183500000X
MST-100122183500000X
TN0000043341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist