Healthcare Provider Details

I. General information

NPI: 1992914899
Provider Name (Legal Business Name): JULIAN HOYT SLADE III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE
DALLAS TX
75203-1201
US

IV. Provider business mailing address

211 SANDPOINT DR
MANSFIELD TX
76063-8600
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-2400
  • Fax:
Mailing address:
  • Phone: 404-514-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21275
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number45396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: