Provider Demographics
NPI:1851578132
Name:SLAMA, JOHN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:SLAMA
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 1:5415 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6451
Mailing Address - Country:US
Mailing Address - Phone:701-866-4757
Mailing Address - Fax:701-373-0686
Practice Address - Street 1:5415 11TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6451
Practice Address - Country:US
Practice Address - Phone:701-866-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist