Provider Demographics
NPI:1689136954
Name:SLOCUM, MATTHEW GILES (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GILES
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SIVLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4470
Mailing Address - Country:US
Mailing Address - Phone:256-265-3400
Mailing Address - Fax:855-331-9970
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4470
Practice Address - Country:US
Practice Address - Phone:256-265-3400
Practice Address - Fax:855-331-9970
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist