Healthcare Provider Details

I. General information

NPI: 1679565741
Provider Name (Legal Business Name): JOHN R SLAGLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LIBERTY ST
CLARION PA
16214-1808
US

IV. Provider business mailing address

100 LIBERTY ST
CLARION PA
16214-1808
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-9310
  • Fax: 814-226-9329
Mailing address:
  • Phone: 814-226-9310
  • Fax: 814-226-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414620L
License Number StatePA

VIII. Authorized Official

Name: JOHN SLAGLE
Title or Position: OWNER
Credential: RPH
Phone: 814-226-9310