Provider Demographics
NPI:1003581604
Name:SALCEDO, STEPHANIE MAE
Entity Type:Individual
Prefix:
First Name:STEPHANIE MAE
Middle Name:
Last Name:SALCEDO
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 1:9511 W PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6002
Mailing Address - Country:US
Mailing Address - Phone:216-545-8353
Mailing Address - Fax:
Practice Address - Street 1:9511 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-6002
Practice Address - Country:US
Practice Address - Phone:216-545-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist