Provider Demographics
NPI:1982046348
Name:SLADECEK, LAURA L (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SLADECEK
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 1:13721 FM 1394
Mailing Address - Street 2:
Mailing Address - City:WORTHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76693-4542
Mailing Address - Country:US
Mailing Address - Phone:254-765-3705
Mailing Address - Fax:
Practice Address - Street 1:2800 W STATE HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2454
Practice Address - Country:US
Practice Address - Phone:903-872-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist