Healthcare Provider Details

I. General information

NPI: 1831704592
Provider Name (Legal Business Name): JOANN SALAS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MADEIRA DR SE
ALBUQUERQUE NM
87108-2963
US

IV. Provider business mailing address

1206 PRESIDIO PL SW
ALBUQUERQUE NM
87105-3639
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1538
  • Fax:
Mailing address:
  • Phone: 505-307-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00006149
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: