Provider Demographics
NPI:1962849554
Name:SLOFFER, NICHOLAS P (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:P
Last Name:SLOFFER
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 1:4120 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1230
Mailing Address - Country:US
Mailing Address - Phone:317-339-6825
Mailing Address - Fax:
Practice Address - Street 1:4120 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1230
Practice Address - Country:US
Practice Address - Phone:317-339-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020474A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist