Healthcare Provider Details

I. General information

NPI: 1508250820
Provider Name (Legal Business Name): SLTN PHARMACY SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MAIN ST
EDGERTON MN
56128
US

IV. Provider business mailing address

2010 JUNIPER AVE
SLAYTON MN
56172-1017
US

V. Phone/Fax

Practice location:
  • Phone: 507-873-2075
  • Fax:
Mailing address:
  • Phone: 507-873-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberTBD
License Number StateMN

VIII. Authorized Official

Name: CHELSEY CARLSON
Title or Position: OWNER/VICE PRESIDENT
Credential: PHARM.D.
Phone: 507-873-2075