Provider Demographics
NPI:1003405010
Name:SALAMI, IMOLEAYO REBECCA
Entity Type:Individual
Prefix:
First Name:IMOLEAYO
Middle Name:REBECCA
Last Name:SALAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 HOLLOW BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2533
Mailing Address - Country:US
Mailing Address - Phone:832-202-3527
Mailing Address - Fax:
Practice Address - Street 1:1002 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6010
Practice Address - Country:US
Practice Address - Phone:713-647-0259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist