Provider Demographics
NPI:1821421488
Name:SLAUGHTER, BRANDON KYLE
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:KYLE
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2034
Mailing Address - Country:US
Mailing Address - Phone:901-475-2157
Mailing Address - Fax:
Practice Address - Street 1:605 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2034
Practice Address - Country:US
Practice Address - Phone:901-475-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-17
Last Update Date:2013-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000037533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist