Provider Demographics
NPI:1063637296
Name:SALZER, LEOPOLD KENNETH IV (ADN, BS PHARM, RPH)
Entity Type:Individual
Prefix:
First Name:LEOPOLD
Middle Name:KENNETH
Last Name:SALZER
Suffix:IV
Gender:M
Credentials:ADN, BS PHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JOEL ST
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174-7785
Mailing Address - Country:US
Mailing Address - Phone:704-233-9409
Mailing Address - Fax:
Practice Address - Street 1:107 JOEL ST
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-7785
Practice Address - Country:US
Practice Address - Phone:704-233-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist