Healthcare Provider Details

I. General information

NPI: 1245284108
Provider Name (Legal Business Name): MARK A SLAGLE PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WEST END AVE, SUITE 1100 MIDSOUTH HEALTHCARE NETWORK
NASHVILLE TN
37203-2570
US

IV. Provider business mailing address

1801 WEST END AVE, SUITE 1100 MIDSOUTH HEALTHCARE NETWORK
NASHVILLE TN
37203-2570
US

V. Phone/Fax

Practice location:
  • Phone: 615-695-2200
  • Fax:
Mailing address:
  • Phone: 615-695-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: