=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124472394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLTN PHARMACY SERVICES, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2016
-----------------------------------------------------
Last Update Date | 04/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 735 MAIN ST
-----------------------------------------------------
City | EDGERTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56128-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-631-0080
-----------------------------------------------------
Fax | 507-631-0089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2010 JUNIPER AVE
-----------------------------------------------------
City | SLAYTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56172-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-873-2075
-----------------------------------------------------
Fax | 507-873-2076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHELSEY CARLSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 507-873-2075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 264703
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------