Provider Demographics
NPI:1750517827
Name:KA SLOAN CORPORATION
Entity type:Organization
Organization Name:KA SLOAN CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-540-4330
Mailing Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:STE 230
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3174
Mailing Address - Country:US
Mailing Address - Phone:704-540-4330
Mailing Address - Fax:704-540-4660
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:STE 230
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-540-4330
Practice Address - Fax:704-540-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NCL000826133V00000X
NC101943336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3415331OtherNCPDP PROVIDER IDENTIFICATION NUMBER