Provider Demographics
NPI:1740566876
Name:SLACHTER, BRANDI E (BSRPH)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:E
Last Name:SLACHTER
Suffix:
Gender:F
Credentials:BSRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16630 E RIRIE HWY
Mailing Address - Street 2:
Mailing Address - City:RIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83443-5016
Mailing Address - Country:US
Mailing Address - Phone:208-538-7498
Mailing Address - Fax:
Practice Address - Street 1:164 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-227-5076
Practice Address - Fax:208-227-5079
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist