Healthcare Provider Details

I. General information

NPI: 1154780070
Provider Name (Legal Business Name): MARIELA SALGADO R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARRETERA PR KM 84.7 PLAZA DEL MAR SHOPPING MALL
HATILLO PR
00659-0000
US

IV. Provider business mailing address

2 CARRETERA PR KM 84.7 PLAZA DEL MAR SHOPPING MALL
HATILLO PR
00659-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-544-4855
  • Fax: 787-544-3122
Mailing address:
  • Phone: 787-544-4855
  • Fax: 787-544-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4717
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: