Healthcare Provider Details

I. General information

NPI: 1518676048
Provider Name (Legal Business Name): JOSEPH A SALEM SR. R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CVS PHARMACY 212 WEST BAGLEY RD
BEREA OH
44017
US

IV. Provider business mailing address

264 SHERI DR
BRUNSWICK OH
44212-1622
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-6676
  • Fax:
Mailing address:
  • Phone: 216-406-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number13907
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13907
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0213907
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: