Provider Demographics
NPI:1316549488
Name:ENRIQUEZ, SALVADOR EDWARD
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:EDWARD
Last Name:ENRIQUEZ
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 1:12308 TERRAZA CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2365
Mailing Address - Country:US
Mailing Address - Phone:512-217-4989
Mailing Address - Fax:
Practice Address - Street 1:3701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-4975
Practice Address - Country:US
Practice Address - Phone:512-353-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist