Provider Demographics
NPI:1255000782
Name:AYALA SALCEDO, MARIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:AYALA SALCEDO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:A
Other - Last Name:SALCEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 GAGE BLVD APT 4047
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8657
Mailing Address - Country:US
Mailing Address - Phone:209-271-8990
Mailing Address - Fax:
Practice Address - Street 1:690 GAGE BLVD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-627-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61169046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist