Healthcare Provider Details

I. General information

NPI: 1548461585
Provider Name (Legal Business Name): GREGORY KENT SLETTEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FRONT ST. SOUTH
BARNESVILLE MN
56514
US

IV. Provider business mailing address

603 6TH AVE. SE P.O. BOX 96
BARNESVILLE MN
56514
US

V. Phone/Fax

Practice location:
  • Phone: 218-354-2131
  • Fax: 218-354-2352
Mailing address:
  • Phone: 218-354-2480
  • Fax: 218-354-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number112079
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: