Provider Demographics
NPI:1548461585
Name:SLETTEN, GREGORY KENT (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:KENT
Last Name:SLETTEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 6TH AVE. SE
Mailing Address - Street 2:P.O. BOX 96
Mailing Address - City:BARNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56514
Mailing Address - Country:US
Mailing Address - Phone:218-354-2480
Mailing Address - Fax:218-354-2352
Practice Address - Street 1:117 FRONT ST. SOUTH
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56514
Practice Address - Country:US
Practice Address - Phone:218-354-2131
Practice Address - Fax:218-354-2352
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist