Active NPI
Corey Richard Slacks
- Pharmacist
- Lithonia, GA
National Provider Identifier
1588264162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH031069
- Practice address
- 5401 Fairington Rd
Lithonia, GA 30038-5113 - Phone
- (770) 598-4998
- NPI assigned
- Oct 31, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH031069 | GA | Primary |
Addresses
Primary practice location
5401 Fairington Rd
Lithonia, GA 30038-5113
Mailing address
2404 Cavalier Xing
Lithonia, GA 30038-5325
Phone (229) 425-6058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH031069 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604102400000",
"number": "1588264162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2404 CAVALIER XING",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300385325",
"telephone_number": "229-425-6058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5401 FAIRINGTON RD",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300385113",
"telephone_number": "770-598-4998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLACKS",
"first_name": "COREY",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-31",
"last_updated": "2020-10-31",
"certification_date": "2020-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH031069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.