Individual
MR. BRACK EDWARD SLATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
119 E JACKSON ST, SUITE 101, GATE CITY, VA 24251-3418
(276) 386-3821
(276) 386-7582
Mailing address
119 E JACKSON ST, SUITE 101, GATE CITY, VA 24251-3418
(276) 386-3821
(276) 386-7582
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202001691
VA
Other
Enumeration date
07/02/2013
Last updated
07/02/2013
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