Provider Demographics
NPI:1083046783
Name:SALASEK, RICHARD P
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:SALASEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 E BELLEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4193
Mailing Address - Country:US
Mailing Address - Phone:480-941-8880
Mailing Address - Fax:
Practice Address - Street 1:2785 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1326
Practice Address - Country:US
Practice Address - Phone:480-947-7574
Practice Address - Fax:480-947-7599
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist