Basic Information
Provider Information
NPI: 1992011522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SLARSKY
FirstName: STEPHEN
MiddleName: M
NamePrefix: MR.
NameSuffix:  
Credential: R.PH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 JARRETT WHITE DRIVE
Address2: TRIPLER ARMY MEDICAL CENTER
City: TRIPLER AMC
State: HI
PostalCode: 968595000
CountryCode: US
TelephoneNumber: 8084335240
FaxNumber:  
Practice Location
Address1: 1 JARRETT WHITE RD
Address2:  
City: TRIPLER AMC
State: HI
PostalCode: 968595001
CountryCode: US
TelephoneNumber: 8084335240
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/20/2010
LastUpdateDate: 08/20/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X16466MAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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