Healthcare Provider Details

I. General information

NPI: 1043583768
Provider Name (Legal Business Name): SUSAN MARIE SALANIK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 7TH AVE
LONGVIEW WA
98632-1605
US

IV. Provider business mailing address

1121 NW 88TH ST
VANCOUVER WA
98665-6925
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-9602
  • Fax: 360-414-9621
Mailing address:
  • Phone: 360-414-9602
  • Fax: 360-414-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00019858
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH- 0009223
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: