Provider Demographics
NPI:1568755643
Name:SALAMON, JIM ALEX (RPH)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:ALEX
Last Name:SALAMON
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 1:144 N MICHIGAN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1869
Mailing Address - Country:US
Mailing Address - Phone:619-750-1274
Mailing Address - Fax:
Practice Address - Street 1:2419 EAST AVENUE S
Practice Address - Street 2:RITE AID
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-274-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist