Provider Demographics
NPI:1255653754
Name:SALKOWS, SALLY A (RPH)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:SALKOWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5744
Mailing Address - Country:US
Mailing Address - Phone:928-453-8118
Mailing Address - Fax:928-453-0027
Practice Address - Street 1:1870 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5744
Practice Address - Country:US
Practice Address - Phone:928-453-8118
Practice Address - Fax:928-453-0027
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist