Provider Demographics
NPI:1245418441
Name:SALACUSE, EDWARD GESWELD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GESWELD
Last Name:SALACUSE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5113
Mailing Address - Country:US
Mailing Address - Phone:302-995-2291
Mailing Address - Fax:302-892-9176
Practice Address - Street 1:4365 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5113
Practice Address - Country:US
Practice Address - Phone:302-995-2291
Practice Address - Fax:302-892-9176
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001737183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA1-0001737OtherPHARMACY STATE LICENSE NO