Healthcare Provider Details

I. General information

NPI: 1841381886
Provider Name (Legal Business Name): SARAH JANE SLAGLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSLE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

103 TANGLEY RD APT 2
MINOT AFB ND
58704-2322
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5296
  • Fax:
Mailing address:
  • Phone: 330-301-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-27439
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: