Healthcare Provider Details

I. General information

NPI: 1972078871
Provider Name (Legal Business Name): COURTNEY RACHEL SLATTEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32905 FORT RD
ROCKWOOD MI
48173-1112
US

IV. Provider business mailing address

47724 DENTON RD
VAN BUREN TWP MI
48111-2254
US

V. Phone/Fax

Practice location:
  • Phone: 734-379-9633
  • Fax:
Mailing address:
  • Phone: 734-652-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5032042989
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: