Provider Demographics
NPI:1740394733
Name:SLAYTON DRUG
Entity Type:Organization
Organization Name:SLAYTON DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-836-6342
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SLAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:56172-0087
Mailing Address - Country:US
Mailing Address - Phone:507-836-6702
Mailing Address - Fax:
Practice Address - Street 1:2622 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SLAYTON
Practice Address - State:MN
Practice Address - Zip Code:56172-1312
Practice Address - Country:US
Practice Address - Phone:507-836-6702
Practice Address - Fax:507-836-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2006633333600000X
MN2006633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2407989OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MN0863450001Medicare NSC