Healthcare Provider Details

I. General information

NPI: 1174927610
Provider Name (Legal Business Name): JAN MARIE SALCIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N LAKE AVE
PASADENA CA
91101-1836
US

IV. Provider business mailing address

160 N LAKE AVE
PASADENA CA
91101-1836
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-0531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: