Provider Demographics
NPI:1952127045
Name:SLADE, TENIA (PHARMD)
Entity type:Individual
Prefix:
First Name:TENIA
Middle Name:
Last Name:SLADE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CHURCHILL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1611
Mailing Address - Country:US
Mailing Address - Phone:864-386-0679
Mailing Address - Fax:
Practice Address - Street 1:111 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2534
Practice Address - Country:US
Practice Address - Phone:864-987-1607
Practice Address - Fax:864-987-9513
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist