Provider Demographics
NPI:1538671136
Name:SALEM, FADI (RPH)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:SALEM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 VIREORIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4815
Mailing Address - Country:US
Mailing Address - Phone:813-966-0046
Mailing Address - Fax:
Practice Address - Street 1:2109 E STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3702
Practice Address - Country:US
Practice Address - Phone:813-684-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist