Provider Demographics
NPI:1295002756
Name:SALTS JR., GLENN
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:
Last Name:SALTS JR.
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 1:1448 N.U.S.HWY.1
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3235
Mailing Address - Country:US
Mailing Address - Phone:561-744-3887
Mailing Address - Fax:561-744-9401
Practice Address - Street 1:1448 N.U.S.HWY.1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-3235
Practice Address - Country:US
Practice Address - Phone:561-744-3887
Practice Address - Fax:561-744-9401
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS17223OtherPHARMACIST