Healthcare Provider Details

I. General information

NPI: 1326525098
Provider Name (Legal Business Name): SLATER CLARK NASH JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 BRYTON DR
POWELL OH
43065-9198
US

IV. Provider business mailing address

7900 E ARROWHEAD PKWY APT 344
SIOUX FALLS SD
57110-7021
US

V. Phone/Fax

Practice location:
  • Phone: 614-581-7935
  • Fax:
Mailing address:
  • Phone: 614-581-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03216503
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number03216503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: