Provider Demographics
NPI:1295729358
Name:SLAYTON, STACEY J (RPH)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:SLAYTON
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:LOCHGELLY
Mailing Address - State:WV
Mailing Address - Zip Code:25866-0130
Mailing Address - Country:US
Mailing Address - Phone:304-461-0068
Mailing Address - Fax:304-461-0071
Practice Address - Street 1:1 PHYSICIANS PLAZA
Practice Address - Street 2:ACCESS HEALTH PHARMACY
Practice Address - City:LOCHGELLY
Practice Address - State:WV
Practice Address - Zip Code:25866
Practice Address - Country:US
Practice Address - Phone:304-461-0068
Practice Address - Fax:304-461-0071
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP0005251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP00005251OtherBOARD OF PHARMACY