Healthcare Provider Details

I. General information

NPI: 1578800413
Provider Name (Legal Business Name): MARTIN STEVEN SALAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 WYOMING BLVD NE
ALBUQUERQUE NM
87113-1946
US

IV. Provider business mailing address

8100 WYOMING BLVD NE
ALBUQUERQUE NM
87113-1946
US

V. Phone/Fax

Practice location:
  • Phone: 505-857-9783
  • Fax: 505-857-9835
Mailing address:
  • Phone: 505-857-9783
  • Fax: 505-857-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005599
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: