Provider Demographics
NPI:1972078871
Name:SLATTEN, COURTNEY RACHEL (RPH)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RACHEL
Last Name:SLATTEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47724 DENTON RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2254
Mailing Address - Country:US
Mailing Address - Phone:734-652-1220
Mailing Address - Fax:
Practice Address - Street 1:32905 FORT RD
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1112
Practice Address - Country:US
Practice Address - Phone:734-379-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5032042989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist