Provider Demographics
NPI:1275830689
Name:SALISBURY, DIANE W (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:W
Last Name:SALISBURY
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 1:20 PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-3866
Mailing Address - Country:US
Mailing Address - Phone:843-997-8268
Mailing Address - Fax:
Practice Address - Street 1:300 S KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-4102
Practice Address - Country:US
Practice Address - Phone:843-626-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist