NPIMap

Individual provider Active NPI

Ryan Alexander Slack

  • Pharmacist
  • Covington, GA
National Provider Identifier
1790318129
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
031522 Issued in GA
Practice address
5341 Highway 20 S
Covington, GA 30016-4409
Phone
(770) 788-4008
NPI assigned
Feb 13, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH031522 GA
Pharmacist 183500000X 031522 GA Primary

Addresses

Primary practice location

5341 Highway 20 S
Covington, GA 30016-4409

Mailing address

5341 Highway 20 S
Covington, GA 30016-4409
Phone (770) 788-4008

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

LicenseStateTypeSpecialty
031522GAMDPharmacist
RPH031522GAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
The Kroger Co PastSince Feb 16, 2020 Accepting new patients
Kroger Co PastSince Feb 16, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1790318129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5341 HIGHWAY 20 S",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164409",
            "telephone_number": "770-788-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 HIGHWAY 20 S",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164409",
            "telephone_number": "770-788-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "RYAN",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH031522",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "031522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.

Verify at the official NPI Registry.